MDICE COVERAGE ISSUE REPORT FORM

This form should be completed by agency radio experts or chiefs/chief officers only.  This form should be used to report any coverage issues experienced by your agency.  Please complete ALL sections of this form providing as much detail as possible.

Form updated: 9/1/08

Exactly where were you located when you experienced the coverage problem? Outdoors in the clear
 Outdoors near large trees
 Outdoors near residential buildings
 Outdoors near large buildings (hospitals, U of I, etc.)
 Inside residential structure (home or small apartment building)
 Inside large buildings (large apartment building, hospital, U of I building, etc.)

Other, please provide description below

 
If you were inside a building, what level of the structure were you on? First Floor
 Second Floor
 Third Floor or above
 Basement
 Sub-Basement
 Was not inside
Please provide a detailed description of your precise location. For example, "I was located near room 124 in the basement of the Illini Union", or "I was about 50 feet south of the Broadway Street entrance to Crystal Lake Park, on the east side".  Be as specific as possible to help us test & duplicate your findings.  
What time did this issue occur? (be as specific as possible so that the log files can be reviewed)
Which talk group were you operating on?
What was the radio ID or Alias of the radio (if known)
Were near any cellular telephone towers at the time of the coverage or interference issue?  If Yes, where was that tower located (address, intersection, etc.)
What type of radio were you using when you experienced this coverage problem? Mobile (fixed in the vehicle)
 Portable
 Both
If the coverage problem was experienced on a portable radio, does your radio have a short or long antenna? Short
 Long
 Only experienced a problem on mobile
If the coverage problem was experienced on a portable radio, is your radio equipped with a public safety mic? (straight cord between the radio and the speaker/mic with a short antenna on top of the speaker/mic) Yes
 No
 Only experienced a problem on mobile
It may be helpful to have you meet with technicians at the trouble spot to show them exactly where you experienced the problem. Would you be willing to do so? Yes
 No
Please provide any other observations or comments regarding this issue:
Your Name:  
Your Department/Agency:  
Your Phone number(s):  
Your E-mail:  
Current Assigned Duty & Shift:  
What is the best time to contact you?:  
What is your supervisors Name:  
What is your supervisors Phone Number:  
What is your supervisors Email address: