Sample Problem Report Form

 

<System/Product Name>

<System/Product Version>

 

Date Reported:

 

Problem ID:

 

Test Phase:

 

Test Case ID:

 

Screen / Process: 

 

Cause/Classification:

 

Test Region:

 

Severity Level

 

Reported By:

 

Priority Level

 

 

Conditions when problem occurred:

 

 

 

 

 

 

 

Brief Description of Problem:  (Attach screen prints, if applicable)

 

 

 

 

 

 

Assigned To:

 

Assigned Date:

 

 

Suggested Workaround:

 

 

 

 

 

 

 

Problem Resolution:

 

 

 

 

 

 

Fix Date:

 

Retest Date:

 

Promotion Date:

 

Retested By:

 

Technical Approver:

 

Pass / Fail:

 

Functional Approver:

 

Closure Date: