ANNEX IV NETWORK MAINTENANCE AND OUTAGE REPORT FORM Table 11: Network Maintenance and Outage Report Form NETWORK MAINTENANCE AND OUTAGE REPORT CONTACT INFORMATION Name of Reporting Entity: Primary Contact Person: Email: Phone Number: MAINTENANCE/OUTAGE INFORMATION Type of outage: ➢ Emergency Services outage ➢ Critical ➢ Major ➢ Planned Maintenance Timing of the Outage Date of Outage: Time Outage Began: Time Outage Resolved: Outage Duration: If not resolved, expected time service(s) to be resolved: Timing of Planned Maintenance Date of Maintenance: Time Maintenance to Begin: Time Maintenance to End: Maintenance Duration: Description of Maintenance/Outage Service(s) affected: Area(s) affected: Network Element(s) affected: Percent of traffic affected: 25