ITD - GOI SMC3AN23 IMAC Form

USER DETAILS (To be filled by the User)

Organization:
Region &
Location:
Address/Site:
Floor/Room No.:
Name:
Extension: Department:
User
Request Date:
Signature:

Install New Old Brief Description of Work Requested

Move
Add
Change
IT Head Authorization
Name Signature Date

CALL DETAILS
Call # Requisition Received Date Time
Call Assigned
Call Completion Date Time
to
Current Asset#
Acquisition No.: _____________________
./Bar-Code #:

Fill for INSTALL Only

Details of the Hardware
Component Installed:

Details of the Software

Component Installed:

New Asset No:

(Please fill the Detailed Inventory Form for new installations with configuration details along with this form)

Fill for ADD / CHANGE Only

Component Name Old Configuration New Configuration
Details of Hardware Component added or
changed:

Details of the Software Component Component Name Old Configuration New Configuration
added or changed (software other than
OS):
ITD - GOI
Fill for MOVE Only
Type of Movement:
Move within Facility
SMC3AN23 IMAC Form
___ Disconnect ___ Shifting ___ Reinstall
Move outside Facility
(Please fill next section if this option is checked)

Fill for MOVE Only (Destination Location Details, In case Move is Outside Current Location)
Organization:
Region: Circle: Location:
Address/Site:

For Support Staff

Site Support Personnel Name:
Site Support Personnel
Signature:

IMAC Request Status

Status: ___ Open ___ Closed ___ Reopened ___ Deferred

User Acceptance
Date: Signature:

Remarks:

Database Update Status

Database Updated (Y/N):
Data Entered By: Date:

-----------------------------------End of IMAC Form--------------------------------------