Technology Problem Report Form

Updated October 22, 2012



Your Name:

Problem is with:
a computer a barcode scanner a software program
a monitor a flatbed scanner a database
a printer other hardware  
Located Where?
CCPL Staff CCPL Public WBL
Administration Computer Lab WBL - Staff
Children's Game Computers - Kids WBL - Public
Circulation Internet - Adult  
Extension Internet - Kids  
Reference Internet - Juniors  
Staff Workroom Internet - Teens  
Tech Services PACs  
Young Adult    
Specific Hardware / Software:

CCPL Tag # OR Serial #:
Both can be found on a white sticker placed on the top or side of the equipment.


property tag


Serial #


What exactly is the problem?
When did the problem start?
Has it worked before? If so, when was the last time it worked?


What has changed since it worked?
Did you get any error messages? What were they?

What other programs were open?

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Thank you :)

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