| Equipment Type: |
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| Manufacturer: |
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| Model Type: |
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| Operating System: |
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| Purchase Date (Month Day Year): |
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| Funding Source: |
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| Cost: |
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| Current Condition: |
1
2
3
4
5
|
| Warranty Status: |
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| Networked? |
Yes No |
| Locked Down? |
Yes No |
| Teacher’s name: |
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| Device (Computer, monitor, printer, or ...?): |
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| Model Name or Number: |
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| Location (Include room number & location in room): |
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| Serial Number: |
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| DESCRIBE THE PROBLEM: |
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| Date Opened: |
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| Date Completed: |
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| Status: |
Open
Closed |
| |
|
