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Use to request decontamination by contaminated units. Initially request on CMD net, then send all traffic through administrative or logistics net. Send initial request with PRIORITY precedence. Reference: FM 3-5.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — TYPE DECON_________________________________(Type of Decontamination Support Required (Operational/Thorough))

LINE 4 — TYPE/QUANTITY______________________________(Type and Quantity of Equipment to be Decontaminated)

LINE 5 — DECON LOCATION ___________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Decontamination Site Location)

LINE 6 — PERSONNEL__________________________________(Number of Personnel Requiring Decontamination)

LINE 7 — TYPE CONTAMINATION_______________________(Type of Contamination (Nuclear, Biological, or Chemical), if Chemical, Type Agent if Known)

LINE 8 — TIME TO DECON______________________________(Request Time to Start Decontaminate)

LINE 9 — LINK-UP POC________________________________(Frequency and Call Sign of Link-Up Point POC)

LINE 10 — CP AT DECON SITE__________________________(Link-up Point Decontamination Assets)

**Repeat lines 3 through 10 to report multiple mission/mission data. Assign sequential line numbers to succeeding iterations; for example, first iteration 3 through 10; second iteration 3a through 10a; third iteration 3b through 10b; and so on.

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

LINE 12 — AUTHENTICATION___________________________(Report Authentication)

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