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Use to provide a status of the civil affairs and civilian-military cooperation and relations situation. Reference: FM 41-10.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — LIAISON_____________________________________(Establishment of and Changes in Liaison Arrangements Between Civil and Military)

LINE 4 — CONTROL___________________________________(Establishment and Changes in Location, Status, Activity of Control Nodes and in the CMO AO)

LINE 5 — AREA OF OPERATIONS________________________(CMO AO Name)

LINE 6 — US CIVILIANS________________________________(Total Number of US Civilians in AO)

LINE 7 — THIRD COUNTRY_____________________________(Total Number of Third Country Civilians in AO)

LINE 8 — FOREIGN NATION____________________________(Total Number of Foreign Nation Civilians in AO)

LINE 9 — TOTAL CIVILIAN POPULATION_________________(Total Civilian Population in the AO)

LINE 10 — MALES UNDER 16____________________________(Total Number of Dislocated Males Under 16 Years of Age)

LINE 11 — UNACCOMPANIED MALES UNDER 16__________(Total Number of Dislocated Unaccompanied Males Under 16 Years of Age)

LINE 12 — MALES OVER 60_____________________________(Total Number of Dislocated Males Over 60 Years of Age)

LINE 13 — MARRIED MALES____________________________(Total Number of Dislocated Married Males)

LINE 14 — SINGLE MALES______________________________(Total Number of Dislocated Single Males)

LINE 15 — FEMALES UNDER 16 _________________________(Total Number of Dislocated Females Under 16 Years of Age)

LINE 16 — UNACCOMPANIED FEMALES UNDER 16________(Total Number of Dislocated Unaccompanied Females Under 16 Years of Age)

LINE 17 — FEMALES OVER 60___________________________(Total Number of Females Over 60 Years of Age)

LINE 18 — MARRIED FEMALES__________________________(Total Number of Dislocated Married Females)

LINE 19 — SINGLE FEMALES____________________________(Total Number of Dislocated Single Females)

LINE 20 — DISLOCATED MALES_________________________(Total Number of Dislocated Males in AO)

LINE 21 — DISLOCATED FEMALES ______________________(Total Number of Dislocated Females in AO)

LINE 22 — TOTAL MALES AND FEMALES_________________(Total Number of Dislocated Males And Females in AO)

LINE 23 — CONTROLLED_______________________________(Total Number of Dislocated Civilians in Controlled Movement)

LINE 24 — UNCONTROLLED____________________________(Total Number of Dislocated Civilians in Uncontrolled Movement)

LINE 25 — MANPOWER_________________________________(Changes in Civilian Manpower Indicate Changes/Shortages in Labor Availability)

LINE 26 — PUBLIC ADMINISTRATION____________________(Changes in Capability to Continue Essential Functions)

LINE 27 — LEGAL______________________________________(Changes in Status of Legal Accommodations and Accords)

LINE 28 — INTELLIGENCE______________________________(Changes in Civilian Attitude; Identification of Collaborators, Agents, and Dissident Elements; Espionage, Sabotage, and Political Subversion)

LINE 29 — LAW AND ORDER____________________________(Changes in Civilian Law and Order)

LINE 30 — PUBLIC HEALTH_____________________________(Changes in Status of Public Health)

LINE 31 — SUPPLY_____________________________________(Changes in Status of Civilian Supplies)

LINE 32 — TRANSPORTATION___________________________(Changes in Status of the Civil Transportation System)

LINE 33 — DRINKING WATER___________________________(Water Potability Status; Potable, Local Only; Nonpotable; to US Standards, as Applicable)

LINE 34 — WATER PRODUCTION________________________(Adequacy of the Water Production Capability; Adequate, Not Adequate, or None, as Applicable)

LINE 35 — SEWAGE TREATMENT________________________(Status of Sewage Treatment; Adequate, Not Adequate, or None, as Applicable)

LINE 36 — REFUSE_____________________________________(Status of Refuse Collection Adequate, Not Adequate, or None as Applicable)

LINE 37 — RADIO______________________________________(Status of the Radio Capability Using OPERATIONAL, NONOPERATIONAL, or UNKNOWN)

LINE 38 — TELEVISION_________________________________(Status of the Television Capability Using OPERATIONAL,

LINE 39 — NEWSPAPER________________________________(Status of the Newspaper Capability Using OPERATIONAL,

LINE 40 — POSTAL_____________________________________(Status of the Postal Capability Using OPERATIONAL, NONOPERATIONAL, or UNKNOWN)

LINE 41 — TELEPHONE_________________________________(Status of the Telephone Capability Using OPERATIONAL,

LINE 42 — TELEGRAPH_________________________________(Status of the Telegraph Capability Using OPERATIONAL,

LINE 43 — TELETYPE___________________________________(Status of the Teletype Capability Using OPERATIONAL,

LINE 44 — ELECTRIC NAVIGATION SYSTEM______________(Status of the Electric Navigation System Using OPERATIONAL, NONOPERATIONAL, or UNKNOWN)

LINE 45 — WORD OF MOUTH___________________________(Status of Word of Mouth Communications Using OPERATIONAL, NONOPERATIONAL, or UNKNOWN)

LINE 46 — CIVIL DEFENSE______________________________(Civil Defense Incidents Affecting Civilian Community, Critical Events, and Assistance Provided US Forces)

LINE 47 — SHORTAGES_________________________________(Changes or Shortages Community (Water Shortages, Quarantines, Road Restrictions, Curfews))

LINE 48 — SUPPORT RECEIVED__________________________(Changes in Support Received From Civilian Community)

LINE 49 — PSYOP______________________________________(Changes in Enemy PSYOP Actions Targeted at Civilian Community)

LINE 50 — PROTECTED PROPERTY_______________________(Changes in Status of Arts, Monuments, and Archives)

LINE 51 — CULTURE___________________________________(Changes in Local Civil, Social, Cultural, Religious, and Ethnic Characteristics)

LINE 52 — RECOMMENDATIONS________________________(Narrative Summary and Recommendations Concerning the Status of Civil-Military Operations Activities)

LINE 53 — NARRATIVE_________________________________(Free Text for Information Required Clarification of Report)

LINE 54 — AUTHENTICATION___________________________(Report Authentication)

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