DA Form 2675-R: Work Injury Certification (LRA)

DA Form 2675-R: Work Injury Certification (LRA) – DA Form 2675-R, titled Certification of Work Incurred Injury or Disability (LRA), is a U.S. Army form used to document and certify injuries or disabilities sustained by Enemy Prisoners of War (EPW) or Civilian Internees (CI) during work assignments.

Prescribed by AR 190-8 (Enemy Prisoners of War, Retained Personnel, Civilian Internees and Other Detainees), the form supports compliance with Geneva Conventions requirements for detainee treatment, including compensation or medical documentation for work-related incidents.

The proponent agency is the Provost Marshal General (PMG). It is a locally reproducible form (LRA) dated May 1982.

Download the official DA Form 2675-R here: https://armypubs.army.mil/pub/eforms/DR_a/pdf/A2675_R.pdf

Purpose of DA Form 2675-R

This form establishes whether an injury or disability incurred by a detainee is attributable to their assigned work. It serves several key functions:

  • Documents circumstances of the incident.
  • Records medical findings and treatment.
  • Provides official certification from both an investigating officer and a medical officer.
  • Supports potential disability compensation or further administrative actions under detainee labor and welfare policies.

It helps ensure humane treatment and accountability in internment and resettlement operations.

Who Uses DA Form 2675-R?

  • Investigating Officers appointed by the camp commander.
  • Medical Officers who evaluate and treat the detainee.
  • Detainee Operations Personnel in EPW/CI camps or facilities.
  • Units involved in internment and resettlement (I/R) operations, as referenced in FM 3-39.40.

It applies in contexts governed by AR 190-8 and related joint publications.

Key Sections of DA Form 2675-R

The form includes the following main parts:

  • Header Information: From/To, Detainee’s Name, Internment Serial Number (ISN), Service Number, Nationality, Power Served, Date of Incident.
  • Injury or Disease: Checkboxes and details on labor performed at the time of injury, place where injured, witnesses, and time.
  • Section I – Investigating Officer: Description of circumstances and opinion on whether the injury/disability is attributable to the work assignment.
  • Section II – Medical Officer: Statement of medical treatment/hospitalization and findings/opinion on work attribution.

Signatures, printed names, grades, and dates are required from both officers.

How to Complete DA Form 2675-R?

  1. Fill in detainee personal and incident details accurately.
  2. The investigating officer completes Section I, describing events and providing an opinion.
  3. The medical officer completes Section II with treatment details and medical opinion.
  4. Ensure all signatures and dates are present.
  5. Distribute copies as required by AR 190-8 (often including one to the detainee and records to the National Prisoner of War Information Center or equivalent).

Always refer to the latest AR 190-8 or command guidance for distribution and follow-up procedures. Use clear, factual language to support potential reviews or claims.

  • AR 190-8: Primary regulation covering EPW, RP, CI, and other detainees, including labor, compensation, and injury procedures.
  • FM 3-39.40 Internment and Resettlement Operations: Provides broader context for detainee forms and operations.
  • Geneva Conventions standards on detainee labor and protection from work-related hazards.

Why Proper Documentation Matters?

Accurate completion of DA Form 2675-R protects the rights of detainees, ensures U.S. forces comply with international law, and maintains detailed records for operational, legal, and humanitarian purposes. In detainee operations, thorough injury documentation supports accountability and proper medical care.

For the most current instructions, consult official Army publications at armypubs.army.mil or your unit’s Provost Marshal or legal advisor.

Note: This form is specific to detainee operations and not used for standard U.S. military or civilian employee workers’ compensation (which use different forms and processes). Always verify with current regulations, as policies can be updated.