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Input form design

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I need to design an input form that could be used to record information about a computer system problem in an instructional lab or a training facility. Include spaces on the form to record information such as:

# system identification
# date and time the problem was reported
# Who reported the problem
# description of the problem
# who was assigned to work on the problem
# problem resolution ( how the problem was fixed)
# Date and time the problem was fixed

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The expert examines input from design.

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I need a design an input form that could be used to record information about a computer system ...

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