Such report shall be made on a form 8½ × 11 inches, arranged in accordance with the form as set out in Appendix 3-A of this section and shall give the following information: the district in which interruption occurred; the week for which report is rendered; the date or dates on which interruptions occurred; the time the company received notification of the interruption; the time the company dispatched its personnel to the scene of the interruption and their arrival time; the times when interruptions began and ended; the duration in hours and minutes of such interruptions; the section of the territory served by the corporation or the municipality affected by such interruption and the approximate number of consumers affected thereby; and the cause or causes of the interruption in reasonable detail. Such report must be signed by a duly authorized officer, or his designee, of such corporation or municipality.