[1] Members name.
Da made
[2] Report: what rule(s) they broke (quote them).
I am not sure if this is strong enough to be reported but the green marked part in the rules quote does it.
[3] Did this affect anyone (e.g. they were using their hacks in PvP)?
mods
[4] Evidence. (If this includes chat, Phase link one or more messages)
[5] Dimension: (if this is a server report).
pve
[6] Roughly, the time (in UTC) the offence was made. (if this is a
server report)
same as report