ESSENTIAL ELEMENTS OF INFORMATION
INTERACTIVE REPORT FORM

DE: (Call Sign)NR: (Message Number) 
PRECEDENCE: Priority (Actual Event) Routine (Exercise) 
Date-Time-Group:
(Local Time is: 
From: (Member's Name/Callsign/State)  
To: (Type each e-mail address separated by a comma.)
For an Actual Event send to: AAN3EEI@WINLINK.ORG 
Exercise EEI reports should be sent to: AFF2EC@WINLINK.ORG
(Note:  If telephone lines are unavailable send it to a station on your Net that has access to e-mail.
If your State or Regional Net is not operational, use TRANSCON.)
Info: (Type info e-mail addresses separated by a comma.)
ZEN: (If appropriate, add additional addresses sent by other means.)
BT
SUBJECT:
1. Reference Identifier:
(Use Applicable Identifier and/or Briefly Describe the Incident in Plain Language) 
A. AREA IMPACTED BY THE INCIDENT:  
(Specify Town, City, County or State-wide area) 
B. STATUS OF EMERGENCY MEDICAL FACILITIES:  
(Operational, Damaged, Destroyed, or Field Facilities available) 
C. STATUS OF LOCAL TRANSPORTATION FACILITIES:  
(Indicate which roads, bridges, local airports, railroads are affected and status - open, restricted, closed, damaged, destroyed. Provide enough information to disaster relief officials to aid in deciding how to get assistance to the affected area)  
D. EXACT LOCATION AND CHARACTERISTICS OF DAMAGE:  
(General description of damage or impact of incident on majorstructures such as Government buildings, schools, residences, commercial properties, public facilities, Fire Stations, Etc. Include locations of shelters if applicable.) 
E. STATUS OF AREA UTILITIES:  
Operational
Damaged
Destroyed
Needed
Status
Not Available
Gas: 
Water: 
Commercial Power: 
Sanitation Systems: 
F. STATUS OF COMMERCIAL COMMUNICATIONS FACILITIES:  
Operational
Damaged
Unavailable
Status
Not Available
Telephone: 
Radio: 
TV: 
Cellular Phone: 
G. SOURCE OF INFORMATION:  
(Indicate Source of information if different fromDATE TIME GROUP of the message. Include MARS Callsign, name of officialand agency, radio/TV station Callsign or network as applicable) 
H. REMARKS:  
(Include comments about expected changes in statusof any of the above items such as power companies expect power to be outfor (specify estimated time). If applicable, include expected time of nextreport.) 
2. EEI REPORT  (Same as Subject Line)
BT
NNNN
/EX

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