Collection Form

We ask you to complete this form to the best of your ability. The information collected will help the FTIS technology department understand patterns of problems in an attempt to come up with a solution for an optimum offsite experience using district-provided equipment. Thank you!

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* 1. Name

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* 2. Are you an employee or student?

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* 3. What district-provided device is experiencing issues?

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* 4. What day of the week did the problem occur? (If the problem occurred on more than one day of the week, pick the first day you noticed it or the day the problem was the worst.)

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* 5. What time of day did you notice the problem? (Again, pick the time of day when the problem was the worst.)

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* 6. Please describe the error to the best of your ability.

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* 7. What is the zip code of the location at which you experienced the issue?

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* 8. Who is your Internet Service Provider? (e.g. Cincinnati Bell FiOptics, Spectrum Cable, etc.)

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* 9. How long did the problem occur?

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* 10. Was any other Internet activity occurring at the same time you noticed the problem? For example, was anyone playing X-Box or watching Netflix during the time you noticed the problem? If yes, please elaborate. If not, please leave blank. 

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* 11. Please rate the level of the problem using the slider scale.
0 = uncomfortable but operational
3 = unusable and extremely frustrating

0 3
i We adjusted the number you entered based on the slider’s scale.

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* 12. If possible, please provide a screenshot of the error.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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