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Use to convey status and disposition of unit's EPWs. Send IAW unit SOPs. Reference: FM 19-40.

LINE 1 -- DATE AND TIME______________________________(DTG)

LINE 2 -- UNIT________________________________________(Unit Making Report)

LINE 3 -- COUNTRY/ NO. EPW OFF/ _____________________(By Country of EPW, Number of EPW NCO/ENL/Officers, Number of Lower Enlisted, Total EPW)

a. Country____________________
b. Enemy Officer: GC____/ Field Grade ____/ CO Grade ____/ WO ____/
c. Enemy Enlisted: CSM____/ E-6 -- E-8 ____/ E-5 -- CPL____/ ENL____/
d. TOTAL NO.___________

LINE 4 -- EPW SITE LOCATIONS ________________________(EPW UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 5 -- NO. EPW MISSING____________________________(Number EPW Missing or Escaped)

LINE 6 -- NO. EPW ESCAPE ATTEMPTS___________________(Number EPW Escape Attempts)

LINE 7 - MEDICAL TREATMENT /EVAC___________________(Number of EPW Requiring Medical Care and/or Are Transferred to the CombatHealth Staff Chain for Medical Evacuation)

LINE 8 -- INCIDENT SUMMARY_________________________(Summary of Incidents)

LINE 9 -- IRC INSPECTION RESULTS_____________________(International Red Cross Inspections Results, if Required)

**Repeat lines 3 through 9 to report multiple mission/mission data. Assign sequential line numbers to succeeding iterations; for example, first iteration 3 through 9; second iteration 3a through 9a; third iteration 3b through 9b; and so on.

LINE 10 -- PM ASSESSMENT ____________________________(PM Assessment)

LINE 11 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 12 -- AUTHENTICATION___________________________(Report Authentication)