LINE 1 -- DATE AND TIME ______________________________(DTG)
LINE 2 -- UNIT ________________________________________(Unit Making Report)
LINE 3 -- TYPE ________________________________________(TABOO, PROTECT, or GUARD)
LINE 4 -- STATUS _____________________________________(Restricted Status of Frequency: NEW, CHANGE, CANCEL, or RENEW)
LINE 5 -- FREQUENCY_________________________________(Frequency (ies))
LINE 6 -- ON TIME ____________________________________(Start DTG of Frequency Restriction)
LINE 7 -- OFF TIME____________________________________(End DTG of Frequency Restriction)
LINE 8 -- LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)
**Repeat lines 3 through 8 as a group to accommodate multiple reportings. Assign sequential line numbers to succeeding iterations; for example, first iteration 3 through 8; second iteration 3a through 8a; and so on.
LINE 9 -- NARRATIVE__________________________________(Free Text for Additional Information Required for Clarification of Report)
LINE 10 -- AUTHENTICATION___________________________(Report Authentication)