LINE 1 -- DATE AND TIME______________________________(DTG)
LINE 2 -- UNIT ________________________________________(Unit Making Report)
LINE 3 -- TGT/OBSTCL NO. _____________________________(Target/Obstacle Number, as per Unit SOPs)
LINE 4 -- EMPLACING SYSTEM _____________________ ____(Emplacing System (Volcano (Air or Ground), Artillery (Type), MOPMS, Air Delivered (Air Force), or Gator)
LINE 5 -- ANTITANK MINES____________________________(Antitank Mines (YES or NO))
LINE 6 -- ANTIPERSONNEL MINES ______________________(Antipersonnel Mines (YES or NO))
LINE 7 -- AIMING POINTS______________________________(Grid Coordinates of Aim Points/Corner Points, if Required Due to Refinement When Authorized)
LINE 8 -- SAFETY ZONE________________________________(Size of Safety Zone)
LINE 9 -- MINEFIELD MARKING_________________________(Type of Marking, if Applicable)
LINE 10 -- LIFE CYCLE_________________________________(DTG of Life Cycle)
LINE 11 -- ACTIONS___________________________________(Actions Taken by Personnel Involved)
LINE 12 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report
LINE 13 -- AUTHENTICATION___________________________(Report Authentication)