Number:

System Malfunction Report

Company: _________
Date: Da /

h/ Year Time ___ : ___

PM

AM

Department: __________

Malfunction Report
High

Priority:

Low

Severity:

Medium

Minor

Series

Fatal
Reported
By:________________________________________________________
Hardware Problem : State -> Type + Model Number + Device IP
Input
Output
I/O Device
Processing
Remote

Software Problem
Input
Output

Network Problem
Input
Output

Processing

Connection

Remote

Processing

Can you reproduce the problem?

Yes
No
What operating system are you using:_______________
Version___________
Describe screen error (Build error):
___________________________________
New plugged-in devices:
_____________________________By_____________
Problem Status

Solved

Resolved
By
.

DD / MM/ YYYY
_AM/PM

Time __:_

Pending
Pending
To..

Expected Fix Date

DD / MM/ YYYY

DD / MM/ YYYY

Attachments
Yes
No
Description_________________________________________________________________________
___

Number:
System Malfunction Report
Company: _________
Date: Da /

h/ Year Time ___ : ___

PM

AM

Department: __________

Specify error
message:______________________________________________
__________________________________________________________________
_
State The Problem:
__________________________________________________________________
__________________________________________________________________
__
Solution :
__________________________________________________________________
_
Is there anyone you can blame for this problem? __________________________________

Problem Status

Solved

Resolved
By
.

DD / MM/ YYYY
_AM/PM

Time __:_

Pending
Pending
To..

Expected Fix Date

DD / MM/ YYYY

DD / MM/ YYYY

Attachments
Yes
No
Description_________________________________________________________________________
___