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Use to share MIJI incidents in a timely manner and to provide for joint exchange of tactical MIJI information including electro-optic interference. Reference: FM 34-10.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — INTERFERENCE______________________________(Strength and Characteristics)

LINE 4 — LOCATION___________________________________(UTM of Affected Station or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 5 — ON TIME _____________________________________(Start DTG)

LINE 6 — OFF TIME_____________________________________(End DTG)

LINE 7 — EFFECTS_____________________________________(Operations/Equipment Affected)

LINE 8 — FREQUENCY _________________________________(Frequency/Frequency Range Affected)

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

LINE 10 — AUTHENTICATION___________________________(Report Authentication)

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