General characteristics:
| Heading and notes: | No form number. O.H.M.S. in serif font above the Crest and ELECTRIC TELEGRAPH, QUEENSLAND in a large gothic font. |
| Message area: | 50 boxes in 10 rows of 5 numbered at the left. |
| Reverse side: | Blank. |
| Colours (text & form): | Black on cream. |
| Size of form overall: | 220 × 204 mm. |
Distinctive characteristics of this form:
Designed, developed and © by Dr. James Johnstone