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Use to report all obstacles on the battlefield after developing a report. Disseminate information and report to all command posts and units in the area of operation as soon as possible. Reference: FM 90-13-1, FM 20-32, and FM 5-34.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — EMPLACING UNIT____________________________(Emplacing Unit, if Known (Enemy, Friendly Unit, Unit))

LINE 4 — APPROVING AUTHORITY______________________(Approving Authority, if Required or Known)

LINE 5 — TARGET/OBSTACLE NO._______________________(Target/Obstacle Number, if Required or Known)

LINE 6 — TYPE OF EMPLACING SYSTEM_________________(Type of Emplacing System, if Required or Known)

LINE 7 — TYPE MINES/OBSTACLES______________________(Type Mines/Obstacle, if Known Include Width and Depth)

LINE 8 — TYPE MARKING SYSTEM______________________(Type Minefield/Obstacle Marking System, if Emplaced)

LINE 9 — LIFE CYCLE DTG______________________________(DTG of Life Cycle/Self-Destruct Time, if Known)

LINE 10 — CORNER LOCATIONS________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Corners)

LINE 11 — REDUCE____________________________________(Obstacle/Minefield Reduced, YES or NO)

LINE 12 — NO. OF LANES_______________________________(Number of Lanes)

LINE 13 — REDUCTION ASSET USED_____________________(MICLIC, Mine Plow, Mine Roller, Demolitions, and so on)

LINE 14 — WIDTH______________________________________(Width of Lane)

LINE 15 — DEPTH______________________________________(Depth of Lane)

LINE 16 — GRID TO START OF LANE_____________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of Start of Lane (Entrance))

LINE 17 — GRID TO END OF LANE_______________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of End of Lane (Exit))

LINE 18 — LANE MARKING_____________________________(Type of Marking System, if Emplaced)

LINE 19 — BYPASS ____________________________________(YES or NO)

LINE 20 — BYPASS GRID _______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator to Bypass)

LINE 21 — BARRIERS___________________________________(Concertina Wire, Pickets, and/or Trenches, and any other obstacle information necessary)

LINE 22 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 23 — AUTHENTICATION___________________________(Report Authentication)