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Use to request authority to execute a planned scatterable minefield (SCATMINE) obstacle. Use the SCATMINREQ to request authority to plan a SCATMINE obstacle and the SCATMINREC to record an executed SCATMINE obstacle. Reference: FM 20-32, FM 90-7, and FM 5-34.

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)