IT Incident Severity Assessment Form
Use this form to report an IT incident and classify its severity for triage and response.
Incident Details
Incident Title / Summary
*
Incident Category
*
Application Outage
Network Issue
Security Alert
Performance Degradation
Access Issue
Data Issue
Hardware Failure
Other
Affected System / Application
*
Incident Start or Discovery Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Scope of Affected Users / Systems
*
Please Select
Single User/System
Small Group (2-10)
Department/Team
Multiple Departments
Organization-wide
Unknown
Other
Severity Assessment
Business Impact
*
Minimal impact
1
2
3
4
5
6
7
8
9
Critical impact
10
1 is Minimal impact, 10 is Critical impact
Urgency
*
Low
Medium
High
Critical
Overall Severity / Priority
*
Please Select
P4 - Low
P3 - Moderate
P2 - High
P1 - Critical
Assessment Factors
Rows
None
Low
Moderate
High
Availability impact
1
2
3
4
Users affected
5
6
7
8
Security impact
9
10
11
12
Workarounds available
13
14
15
16
Reporter Information
Reporter Name
*
Reporter Contact
*
Submit Assessment
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