Free Da 2166 9 1 Form in PDF Make Your Document Now

Free Da 2166 9 1 Form in PDF

The DA Form 2166-9-1 is an essential document used for evaluating the performance of Non-Commissioned Officers (NCOs) in the U.S. Army. This form captures vital administrative data, performance evaluations, and feedback from raters and senior raters. Understanding its components is crucial for ensuring accurate assessments and fostering professional development within the ranks.

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Similar forms

  • DA Form 2166-9-2: This form is used for evaluating NCOs at the rank of Staff Sergeant and above. Similar to the DA 2166-9-1, it includes sections for administrative data, authentication, duty description, and performance evaluation.

  • DA Form 1059: This document is a service school academic evaluation report. Like the DA 2166-9-1, it assesses performance and includes sections for comments from evaluators.

  • DA Form 67-9: This form is used for officer evaluation reports. It shares similarities in structure, including sections for administrative data and performance evaluations.

  • DA Form 4856: This is a developmental counseling form. It also includes sections for documenting counseling sessions and performance, similar to the evaluation aspects of the DA 2166-9-1.

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  • DA Form 67-10: This is used for evaluating warrant officers. It has a similar structure, with sections for performance evaluation and overall potential.

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Document Sample

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NCO EVALUATION REPORT (SGT)

For use of this form, see AR 623-­3 and DA PAM 623-­3 the proponent agency is DCS, G-­1.

SEE PRIVACY ACT STATEMENT

IN AR 623-­3

PART I ADMINISTRATIVE DATA

a.NAME (Last, First, Middle Initial)

b. SSN (or DOD ID No.)

c. RANK

d. DATE OF RANK

e. PMOSC

f. UNIT, ORG, STATION, ZIP CODE OR APO, MAJOR COMMAND

g. STATUS CODE

h. UIC

i. REASON FOR SUBMISSION

j. PERIOD COVERED

FROMTHRU

YEAR MONTH DAY

YEAR MONTH DAY

k.RATED MONTHS

l.NONRATED CODES

m. NO OF ENCLOSURES

n. RATED NCO'S EMAIL ADDRESS (.gov or .mil)

PART II AUTHENTICATION

a1. NAME OF RATER (Last, First, Middle Initial)

a2. SSN (or DOD ID No.)

a3. RATER'S SIGNATURE

a4. DATE (YYYYMMDD)

a5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

a6. RATER'S EMAIL ADDRESS (.gov or .mil)

b1. NAME OF SENIOR RATER (Last, First, Middle Initial)

b2. SSN (or DOD ID No.)

b3. SENIOR RATER'S SIGNATURE

b4. DATE (YYYYMMDD)

b5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

b6. SENIOR RATER'S EMAIL ADDRESS (.gov or .mil)

c1. SUPPLEMENTARY

c2. NAME OF SUPPLEMENTARY REVIEWER

c3. RANK

PMOSC/

ORGANIZATION

DUTY ASSIGNMENT

REVIEW REQUIRED?

(Last, First, Middle Initial)

 

 

BRANCH

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c4. COMMENTS

 

c5. SUPPLEMENTARY REVIEWER'S SIGNATURE

c6. DATE(YYYYMMDD)

 

c7. SUPPLEMENTARY REVIEWER'S EMAIL ADDRESS

ENCLOSED?

 

 

 

 

 

 

(.gov or .mil)

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RATED NCO: I understand my signature does not constitute agreement or disagreement with the assessments of the rater and senior rater. I further understand my signature verifies that the administrative data in Part I, the rating officials and counseling dates in Part II, the duty description in Part III, and the APFT and height/weight entries in Part IVa and IVb are correct. I have seen the completed report. I am aware of the appeals process of AR 623-­3.

d1. COUNSELING DATES INITIAL

LATER

LATER

LATER

d2. RATED NCO'S SIGNATURE

d3. DATE (YYYYMMDD)

PART III DUTY DESCRIPTION (Rater)

a. PRINCIPAL DUTY TITLE

b. DUTY MOSC

c.DAILY DUTIES AND SCOPE (To include, as appropriate, people, equipment, facilities, and dollars)

d.AREAS OF SPECIAL EMPHASIS

e.APPOINTED DUTIES

PART IV PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)

a. APFT Pass/Fail/Profile:

Date:

b. Height:

Weight:

Within Standard?

(Comments required for "Failed" APFT, "No" APFT, or "Profile" when it precludes performance of duty, and "No" for Army Weight Standards.) Reset Item a. APFT/Pass/Fail/Profile

c.CHARACTER: (Include bullet comments addressing Rated NCO's performance as it relates to adherence to Army Values, Empathy, Warrior Ethos/Service Ethos, and Discipline. Fully supports SHARP, EO, and EEO.)

MET

DID NOT MEET

STANDARD

STANDARD

COMMENTS:

DA FORM 2166-­9-­1, NOV 2015

Page 1 of 2

APD LC v1.00ES

RATED NCO'S NAME (Last, First, Middle Initial)

SSN (or DOD ID No.)

THRU DATE

 

 

 

PART IV PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)

d. PRESENCE: (Military and professional

COMMENTS:

bearing, Fitness, Confidence, Resilience.)

 

MET

DID NOT MEET

 

STANDARD

STANDARD

 

e. INTELLECT: (Mental agility, Sound judgment, COMMENTS:

Innovation, Interpersonal tact, Expertise.)

MET

DID NOT MEET

STANDARD

STANDARD

f. LEADS: (Leads others, Builds trust, Extends COMMENTS:

influence beyond the chain of command, Leads by

example Communicates.)

 

MET

DID NOT MEET

STANDARD

STANDARD

g. DEVELOPS: (Creates a positive command/ COMMENTS:

workplace environment, Fosters esprit de corps,

Prepares self, Develops others, Stewards the

profession.)

 

MET

DID NOT MEET

STANDARD

STANDARD

 

 

h. ACHIEVES: (Gets results.)

COMMENTS:

MET

DID NOT MEET

STANDARD

STANDARD

 

 

 

 

 

 

RATER OVERALL PERFORMANCE

 

i. I currently rate

NCOs in this grade.

 

COMMENTS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART V SENIOR RATER OVERALL POTENTIAL

a. Select one box representing Rated

b. COMMENTS:

 

NCO’s potential compared to others in the

 

 

same grade whom you have rated in your

 

 

career. I currently senior rate

 

 

NCOs in this grade.

 

 

 

 

 

 

 

 

 

 

 

 

MOST QUALIFIED

 

 

 

 

 

 

HIGHLY QUALIFIED

 

 

QUALIFIED

 

 

 

 

 

 

NOT QUALIFIED

 

 

 

 

 

 

 

 

 

c. List two successive assignments and one broadening assignment (3-­5 years).

 

Successive Assignment:

1)

 

 

2)

Broadening Assignment:

 

 

 

DA FORM 2166-­9-­1, NOV 2015

 

Page 2 of 2

 

 

 

 

 

 

 

APD PE v1.00ES

Key takeaways

When filling out and using the DA 2166-9-1 form, it is essential to keep several key points in mind:

  • Accurate Information: Ensure that all administrative data, including names, ranks, and dates, is filled out correctly. Errors can lead to complications in the evaluation process.
  • Understand Your Role: The rated NCO should be aware that signing the form does not indicate agreement with the evaluations. It simply confirms that the information provided is accurate.
  • Performance Evaluation: The rater must provide clear and specific comments on various aspects of the rated NCO’s performance, including character, presence, and leadership abilities.
  • Senior Rater Input: The senior rater plays a crucial role in assessing the rated NCO’s overall potential. Their evaluation should compare the NCO to others in the same grade.
  • Review Process: Familiarize yourself with the appeals process outlined in AR 623-3. Understanding this process can be beneficial if there are concerns about the evaluation.

Instructions on How to Fill Out Da 2166 9 1

After gathering the necessary information, you can begin filling out the DA Form 2166-9-1. This form is essential for documenting the performance of a Non-Commissioned Officer (NCO). Ensure that all information is accurate and complete before submission.

  1. Start with Part I - Administrative Data. Fill in the following fields:
    • a. NAME (Last, First, Middle Initial)
    • b. SSN (or DOD ID No.)
    • c. RANK
    • d. DATE OF RANK
    • e. PMOSC
    • f. UNIT, ORG, STATION, ZIP CODE OR APO, MAJOR COMMAND
    • g. STATUS CODE
    • h. UIC
    • i. REASON FOR SUBMISSION
    • j. PERIOD COVERED FROM/THRU (YEAR, MONTH, DAY)
    • k. RATED MONTHS
    • l. NONRATED CODES
    • m. NO OF ENCLOSURES
    • n. RATED NCO'S EMAIL ADDRESS (.gov or .mil)
  2. Proceed to Part II - Authentication. Complete the following:
    • a1. NAME OF RATER (Last, First, Middle Initial)
    • a2. SSN (or DOD ID No.)
    • a3. RATER'S SIGNATURE
    • a4. DATE (YYYYMMDD)
    • a5. RANK PMOSC/BRANCH ORGANIZATION DUTY ASSIGNMENT
    • a6. RATER'S EMAIL ADDRESS (.gov or .mil)
    • b1. NAME OF SENIOR RATER (Last, First, Middle Initial)
    • b2. SSN (or DOD ID No.)
    • b3. SENIOR RATER'S SIGNATURE
    • b4. DATE (YYYYMMDD)
    • b5. RANK PMOSC/BRANCH ORGANIZATION DUTY ASSIGNMENT
    • b6. SENIOR RATER'S EMAIL ADDRESS (.gov or .mil)
    • c1. SUPPLEMENTARY
    • c2. NAME OF SUPPLEMENTARY REVIEWER (Last, First, Middle Initial)
    • c3. RANK PMOSC/ORGANIZATION DUTY ASSIGNMENT
    • c4. COMMENTS
    • c5. SUPPLEMENTARY REVIEWER'S SIGNATURE
    • c6. DATE (YYYYMMDD)
    • c7. SUPPLEMENTARY REVIEWER'S EMAIL ADDRESS (.gov or .mil)
    • ENCLOSED? (YES/NO)
  3. In Part III - Duty Description, provide details about the rated NCO's role:
    • a. PRINCIPAL DUTY TITLE
    • b. DUTY MOSC
    • c. DAILY DUTIES AND SCOPE
    • d. AREAS OF SPECIAL EMPHASIS
    • e. APPOINTED DUTIES
  4. Next, move to Part IV - Performance Evaluation. Fill in the performance metrics:
    • a. APFT Pass/Fail/Profile: Date
    • b. Height: Weight: Within Standard? (Provide comments as necessary)
    • c. CHARACTER: Provide bullet comments on performance
    • d. PRESENCE: Provide bullet comments on military and professional bearing
    • e. INTELLECT: Provide bullet comments on mental agility and judgment
    • f. LEADS: Provide bullet comments on leadership qualities
    • g. DEVELOPS: Provide bullet comments on developing others
    • h. ACHIEVES: Provide bullet comments on results achieved
    • i. RATER OVERALL PERFORMANCE: Provide comments
  5. Finally, complete Part V - Senior Rater Overall Potential:
    • a. Select one box representing Rated NCO’s potential
    • b. Provide comments
    • c. List two successive assignments and one broadening assignment