ICT TECHNICAL ASSISTANCE (TA) FORM

CLIENT INFORMATION Short Description of your Request/Problems

First Name: ____________________________________________ Encountered:
Last Name: ____________________________________________ ____________________________________________________________
Office/School: _________________________________________ ____________________________________________________________
Date of Request: _________________________ ____________________________________________________________
Time of Request: _________________________ ____________________________________________________________
If Applicable: ____________________________________________________________
District/Cluster: _________________________ ____________________________________________________________
School Head: __________________________________________ ____________________________________________________________
Contact No.: ________________________ ____________________________________________________________
ICT Coordinator: ______________________________________ ____________________________________________________________
Contact No.: ________________________ ____________________________________________________________
For DepED Email Creation/Reset/Suspension/Deletion: ____________________________________________________________
Middle Name: _______________________________________ ____________________________________________________________
DepED Email: ____________________________ ____________________________________________________________
Recovery Information: ____________________________________________________________
Personal E-Mail: __________________________________ ____________________________________________________________
Permanent Mobile No.: __________________________ ___________________________________
---for the ICT Unit---
NATURE Hardware Software Network Others
1. Printer 4. Internal 7. OS 10. Installation 13. LAN Configuration 16. DCP
OF 2. System Unit 5. Peripherals 8. Drivers 11. Update 14. Router/Cables
REQUEST 3. Monitor/Display 6. Connectors/Plugs/Power 9. Malware 12. Files/Data 15. Internet
ITEM DESCRIPTION SERIAL NO. PROBLEM/ISSUE
(Property Number) (Please specify) (Please specify)
FINDINGS
ACTION
TAKEN

STATUS/RECOMMENDATION:
( ) GOOD/RETURNED ( ) CHECK FOR AUTHORIZED SERVICE CENTER ( ) FOR PART REPLACEMENT ( ) UNSERVICEABLE

CLIENT FEEDBACK (SDO Client): Client (SDO Proper)/ Noted/Processed by:

Excellent
Very
Good
Good Satisfactorily School Head (Schools):
(4) (2) (1)
(3)

Date Finished: ________________________ ORLANDO L. NICOLAS, JR.

Signature Over Printed Name
Time Finished: ________________________
Information Technology Officer I

Alibagu, City of Ilagan, Isabela 3300 deped-isabela.com.ph

(078) 323-0281; (078) 323-2015 Sdo Isabela
isabela@deped.gov.ph
Doc Code: FM-SDS-ICT-001 Rev: 01
As of: Sept 12, 2019 Page: 1