Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Schools Division of Santiago City

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

 DEPED EMAIL PROCESSED: (CREATED/RESET/TRANSFERRED OU)  SOFTWARE PROBLEM RESOLVED

 HARDWARE PROBLEM RESOLVED: (GOOD/RETURNED)  SOFTWARE PROBLEM PENDING
 HARWARE PROBLEM FORWARED TO: (SERVICE CENTER/FOR PART REPLACEMENT & PROCUREMENT/UNSERVICEABLE)
TAKENACTION

Other Details (If any):

__________________________________________________________________________________________________________________________________________________________

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__________________________________________________________________________________________________________________________________________________________

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CLIENT FEEDBACK Client (SDO Proper)/ Noted/Processed by:
(SDO Client Only): School Head (Schools):
Very
Excellent Good Satisfactorily
Good
(4) (2) (1)
(3)

RICARDO Q. CABUGAO, JR.

Date Finished: _____________________ Signature Over Printed Name Information Technology Officer I
Time Finished: _____________________ Date: _________________ Date: _________________

Address: Childrens Park, Calaocan, Santiago City, 3311

Telephone Nos.: (078) 682-0151; (078) 682-0156
Email Address: santiago.city@deped.gov.ph
Doc Code: FM-SDS-ICT-001 Rev: 02
Website: deped-santiagocity.com.ph As of: Feb 17, 2020 Page: 1