LINE 1 -- DATE AND TIME______________________________(DTG)
LINE 2 -- UNIT________________________________________(Unit Making Report)
LINE 3 -- INTERFERENCE______________________________(Strength and Characteristics)
LINE 4 -- LOCATION___________________________________(UTM of Affected Station or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)
LINE 5 -- ON TIME _____________________________________(Start DTG)
LINE 6 -- OFF TIME_____________________________________(End DTG)
LINE 7 -- EFFECTS_____________________________________(Operations/Equipment Affected)
LINE 8 -- FREQUENCY _________________________________(Frequency/Frequency Range Affected)
LINE 9 -- NARRATIVE__________________________________(Free Text for Additional Information Required for Clarification of Report)
LINE 10 -- AUTHENTICATION___________________________(Report Authentication)