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Use to report a periodic update, forecast, or formal request of Class IV barrier materials a unit requires. Reference: FM 5-102, FM 20-32, and FM 90-7.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — REQUEST TYPE_______________________________(Update, Forecast, or Request)

LINE 4 — MATERIALS__________________________________(Type) a) Pickets
__________________________________________________________ b) Wire
__________________________________________________________ c) Sand Bags
__________________________________________________________ d) Wood Type/Size

LINE 5 — QTY OH______________________________________(Specify)

**Repeat as Required

LINE 6 — QTY REQ_____________________________________(Required Quantity)

**Repeat as Required

LINE 7 — UOM________________________________________(Unit of Measurement Times Number Requested)

LINE 8 — MOR________________________________________(Method of Resupply Requested (Aerial, LOGPAC))

LINE 9 — LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator) to Class IV Supply Point or LRP)

LINE 10 — NLT TIME___________________________________(Time Limit For Class IV to Arrive at Supply Point)

LINE 11 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 12 — AUTHENTICATION___________________________(Report Authentication)

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