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Trunk Radio System Occurrence Reporting Form

Reporter Information

* Agency:
*Last Name: *First Name:
*Submission Date: (mm/dd/yyyy) Contact Title:
Contact Email: Contact Phone:   Ext

Occurrence Information

Date(mm/dd/yyyy):         Time: 
Street Address:
City: State:  Zip:  
Type:
Use: In Street In Building
Weather: Clear Cloudy Raining Snowing Fog

Note:   The event reported should be related to mobile radio use- not a portable transceiver.

What Talk Group (Channel) was being used?           Zone A:  Zone B:
Have you experienced this problem before?          

Please describe occurrence in detail:
Please press submit to electronically submit or fax to 813-4106.