Maintenance Request Form

Before filling Out this Form, Please refer to the Trouble Shooting Guide

Name
Campus
Room #
Machine Name
Date
Hardware Problem: Place an X in the appropriate field
Power won't come on
Hard drive error message
Monitor problem -- describe
CD ROM error
I can hear the fan, but nothing on the screen
Floppy drive error
Speakers won't work
Printer problems -- describe
 
Please describe specific  problem in detail
Software Problem: Place an X in the appropriate field
Need software loaded -- describe
Software not working properly -- describe
Can't access network folder --name of folder & server
Need a driver for ---describe
Other -- describe
DESCRIBE  
Please describe specific  problem in detail
Network Problem: Place an X in the appropriate field
Can't log on
Can't access information -- describe what folder & server
Can't access Internet
Can't send email
Can't receive email
DESCRIBE -- other  
Please describe specific  problem in detail
When you are satisfied with your input, please press submit.

For Tech Department ONLY

Please supply: DATE and ACTION TAKEN:

ACTION STILL NEEDED:

Recipient's Signature