LINE 1 -- DATE AND TIME______________________________(DTG)
LINE 2 -- UNIT________________________________________(Unit Making Report)
LINE 3 -- EMPLACING UNIT____________________________(Emplacing Unit, if Known (Enemy, Friendly Unit, Unit))
LINE 4 -- APPROVING AUTHORITY______________________(Approving Authority, if Required or Known)
LINE 5 -- TARGET/OBSTACLE NO._______________________(Target/Obstacle Number, if Required or Known)
LINE 6 -- TYPE OF EMPLACING SYSTEM_________________(Type of Emplacing System, if Required or Known)
LINE 7 -- TYPE MINES/OBSTACLES______________________(Type Mines/Obstacle, if Known Include Width and Depth)
LINE 8 -- TYPE MARKING SYSTEM______________________(Type Minefield/Obstacle Marking System, if Emplaced)
LINE 9 -- LIFE CYCLE DTG______________________________(DTG of Life Cycle/Self-Destruct Time, if Known)
LINE 10 -- CORNER LOCATIONS________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Corners)
LINE 11 -- REDUCE____________________________________(Obstacle/Minefield Reduced, YES or NO)
LINE 12 -- NO. OF LANES_______________________________(Number of Lanes)
LINE 13 -- REDUCTION ASSET USED_____________________(MICLIC, Mine Plow, Mine Roller, Demolitions, and so on)
LINE 14 -- WIDTH______________________________________(Width of Lane)
LINE 15 -- DEPTH______________________________________(Depth of Lane)
LINE 16 -- GRID TO START OF LANE_____________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Start of Lane (Entrance))
LINE 17 -- GRID TO END OF LANE_______________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of End of Lane (Exit))
LINE 18 -- LANE MARKING_____________________________(Type of Marking System, if Emplaced)
LINE 19 -- BYPASS ____________________________________(YES or NO)
LINE 20 -- BYPASS GRID _______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator to Bypass)
LINE 21 -- BARRIERS___________________________________(Concertina Wire, Pickets, and/or Trenches, and any other obstacle information necessary)
LINE 22 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)
LINE 23 -- AUTHENTICATION___________________________(Report Authentication)