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Use to convey status of military equipment deemed sensitive by chain of command. Send IAW unit SOPs. Reference: FM 19-30.

LINE 1 -- DATE AND TIME______________________________(DTG)

LINE 2 -- UNIT________________________________________(Unit Making Report)

LINE 3 -- STATUS _____________________________________(UP-100 percent Complete or UNIT GREEN to Denote Report With No Discrepancy; if Unit is Green Skip to Line 10; When Discrepancy is Noted Report UNIT RED and Continue Report)

LINE 4 -- LOSING UNIT________________________________(Unit Making Report Loss)

LINE 5 -- ITEM _______________________________________(Item Lost by Serial Number)

LINE 6 -- DTG OF LOSS________________________________(DTG of Loss)

LINE 7 -- DETAILS_____________________________________(Circumstances of Loss)

LINE 8 -- ACTION TAKEN ______________________________(Actions Taken to Recover the Item)

LINE 9 -- NARRATIVE__________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 10 -- AUTHENTICATION___________________________(Report Authentication)