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Use to report the status of the unit’s personnel. Reference: FM 12-6.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — FROM_______________________________________(DTG for the Beginning of Period Applying to Personnel Information)

LINE 4 — TO__________________________________________(DTG for the End of Report Period)

LINE 5 — UNIT ________________________________________(Designation of the Unit for Which the Personnel Status Information is Being Submitted)

LINE 6 — AUTHORIZED_________________________________(Number of Personnel Authorized by Personnel Classification)

LINE 7 — ASSIGNED ___________________________________(Number of Personnel Assigned by Personnel Classification)

LINE 8 — ON HAND____________________________________(Number of Personnel Authorized by Personnel Classification)

LINE 9 — GAINS_______________________________________(Number of Personnel Gains by Personnel Classification)

LINE 10 — REPLACEMENTS_____________________________(Number of Personnel Gained That Are Replacements by Personnel Classification)

LINE 11 — RETURNED TO DUTY_________________________(Number of Personnel Gained That Have Been Returned to Duty Through Medical Channels by Personnel Classification)

LINE 12 — KILLED_____________________________________(Number of KIA by Personnel Classification)

LINE 13 — WOUNDED__________________________________(Number of WIA by Personnel Classification)

LINE 14 — NONBATTLE LOSS___________________________(Number of Disease Nonbattle Injury Loss by Personnel Classification)

LINE 15 — MISSING____________________________________(Number of MIA by Personnel Classification)

LINE 16 — DESERTERS_________________________________(Number of Deserters by Personnel Classification)

LINE 17 — AWOL______________________________________(Number Absent Without Leave by Personnel

LINE 18 — CAPTURED__________________________________(Number of Enemy Personnel Captured Duringthe Reporting Period)

**Repeat lines 5 through 18 to indicate the personnel summary of additional units. Assign sequential line numbers to succeeding iterations; for example, first iteration 5 through 18; second iteration 5a through 18a; third iteration 5b through 18b, and so on.

LINE 19 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 20 — AUTHENTICATION___________________________(Report Authentication)

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