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Please fill out the top section of this form and give it to the appropriate person listed below:
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Equipment Malfunction (DVD, VCR, LCD Projector, Digital Camera, Document Reader, etc)....................................Mr. Berndt, Media Specialist
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Hardware /Software Problems (within the classroom)................................................................................................Mr. Lawson
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Network Problems, Printer Problems (outside of the classroom)...............................................................................Mr. Berndt, Media Specialist
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Computer Lab Problems..........................................................................................................................................-Mr. Berndt, Media Specialist
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Video Distribution System........................................................................................................................................-Mr. Berndt, Media Specialist
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Circle the appropriate area: Classroom Computer, Classroom Printer, Computer Lab, Video Distribution System, Network, TV, VCR, DVD,
Digiital Camera, LCD Projector, Document Readers.
Name: Room:
Date Submitted:
Problem (in detail please):
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This section to be completed and signed by person responsible for this area:
Actions taken and results of Actions:
Maintenance Completed by: Date Completed:
Specific Time: Total Minutes Spent:
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