*First Name

*Last Name

*Agency EMS B.C.S.O. Clark Fork Ambulance CCBFD Dept of Lands East Pend Oreille Fire Dept. Fish & Game Idaho State Police (ISP) Newport Ambulance North Narrows Fire Department Northside Fire Department Ponderay Police Department Priest River Police Department Priest Lake Ambulance P.L.S.A.R. Sandpoint Fire Department Sandpoint Police Department Schweitzer Fire Department Spirit Lake Fire Department Timberlake Fire Department USFS West Pend Oreille Fire Department West Priest Lake Fire Department West Side Fire Department other

Email Address

Phone

What type of radio is having the issue?

Radio Make Motorola Macom Harris Icom Kenwood other

Radio Model P 7100 HT 1250 HT 1000 TK 272 other

Serial or Identification Number

Unit # if Mobile or Vehicular Repeater is selected

If Portable Radio is selected

Is the same problem on both your mobile and your portable radio?

If Mobile or Vehicular Repeater Selected:Was antenna attached and clear of snow and debris?

If you selected a repeater issue, select the repeater location:

Occurrence Date and Time:

Weather conditions at time of problem

Problem happens?

Additional details Add any additional details you believe may help in determining the issue

Location issue occured

What channels did problems occur on?

More Details

Volume

Age of Battery

If it's a Portable Battery, how long does it last?

What level of charge is left on the battery?

Date radio was last at a repair facility?

Other Details/Circumstances/Explanations: