HELP TICKET FORM
Submitter First Name*
Submitter Last Name*
Your Email* - You'll receive a confirmation for this submission.
VEHICLE
Choose one
07 BOX TK
10 BOX
AL
ANDY
ANITA
ART
BARNEY
BASHFUL
BEN
BETTY
BILLY
BO
BRUCE VEIN
BUZZ
CHANDLER
CHARLIE
CHER
DOC
DOPEY
ERIC
ERNIE
EX3A
EXEC 0A
EXEC2
EXEC21
FRED
GEORGE
GRUMPY
GUS
H11
H12
H16
H17
HANK
HAPPY
HBT1
HBT10
HBT11
HBT12
HBT13
HBT14
HBT15
HBT16
HBT2
HBT3
HBT4
HBT5
HBT6
HBT7
HBT8
HBT9
HOPE
JEN
JOEY
LARRY
LUKE
LYNN
MAC
MATT
MAVERICK
MBT1
MBT2
MM01
MM02
MM03
MM04
MM05
MM06
MOLLY
MONICA
MS01
MS02
N07
N08
N10
N11
N13
N14
N15
N16
N18
N19
N20
N21
N22
N23
N24
N25
N26
N28
N29
None
NP01
NP02
NP03
NR01
NR02
NR03
NR04
NR05
NR06
NR07
NR08
NR09
NR10
NR11
NR12
NR13
NR14
NR15
OD6
OD7
PHIL
PHOEBE
RACHEL
ROSS
SAM
SCARLETT
Shop Truck 14
Shop Truck 19 2500
Shop Truck 20
Shop Truck 3500 A (Mobile Shop Truck)
Shop Truck 3500 B (GMC Shop Truck)
Shop Truck CSC
SLEEPY
T02
T03
T04
T09
T11
T14
T15
T17
T19
T20
T21
T22
T23
T24
T25
T27
T29
T30
T31
T32
T33
T34
T35
T36
T37
T38
T39
T40
T41
T42
T43
T44
T45
TC01
TC02
TC03
THOMAS
Tower 1
Tower 11
Tower 12
Tower 13
Tower 14
Tower 15
Tower 16
Tower 17
Tower 2
Tower 3
Tower 4
Tower 5
Tower 6
Tower 7
Tower 8
Tower 9
TR10
TR11
TR12
TR4
TR5
TR6
TR7
TR8
TR9
VERONICA
WILL
WILMA
LOCATION*
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Asheville
Augusta
Charleston
Columbia
Easley
Florence
Glenwood
Greenville SC - Woodruff Rd
Greenwood
Hendersonville
Kitty Hawk
Matrix
Myrtle Beach
Other
Savannah
Seneca
Spartanburg
Statesville
Winterville - Greenville NC
DIVISION*
Choose one
CSC - Coastal South Carolina
ENC - Eastern North Carolina
Georgia
Matrix
SCFS - South Carolina Fixed Sites
SCM - South Carolina Mobiles
WNC - Western North Carolina
EQUIPMENT / SYSTEM*
Access to Outside Website(s)
Antibody Testing in TBC Rewards
Appointment - Staging Dashboard
Authenticator
BacT Site
BDER Blood Drive Efficiency Rating
bexWISE AFFIRM
bexWISE PROCESS
Blood Drive Adjustment Site
Blood Drive Adjustment Users
BloodBill
Bloodhub
CCP SharePoint Related Sites
Center Audit Site
Center Gift Boxes Site
Clearbuilt
CMRS
Complaint Site
Computer (Desktop/Tower)
Computer (Laptop)
Computer (Peripherals)
Computer (Tablet)
Concur
CovidABTesting App
Cradlepoint
DER Donor Eligibility Report
DOD Docs On Disc - Computer
Domain Issues
DR Support Ticket Site
Drive Code Request
EAF Site
EBR (Electronic Batch Release - Pre Lot Release)
EEOC Compliance Site
Email (Exchange)
Email (Office 365)
Employee Survey and Performance Scorecard
Equipment Request
External Therapeutic Orders Form
Facilities Ticket System Update
Fax Finder
Finance Budget Site
Finance Budget Updater Site
Fleetio
Forensics Site
FTP Site
GeoTab
Gift Card Mobile Staging
Global Protect
GoSecure
HemaCollect
HemaComply
HemaConnect CRM (Staff version)
Hold Form
Hospital Contract Site
Hospital Customer Information
HR Ticket System
Immunohematology Workup Summary Site
Infrastructure and Security
Internal Therapeutic Orders Site
Isensix
IT Ticket System Update
Lab Requisition Form
Marketing Forms Site
MFA
Microsoft Office
Mobile Audit Site
Network/Ports/Patches
None
Not Sure -or- Multiple Systems Affected
PAF Site
Parvo
PDQ Deployment
Permission Issues
Phone (MiTel)
PowerBI
PRIDE SITE
Printer
Proactive Eligibility
Production Planning Site
PTO Cash Out Site
PTO Request Site
Purchasing Ticket System
Raw Materials
RedPhone
Remote PC Connection (Teamviewer and/or Remote Desktop)
Retail Planning and Tracking Dashboard
Retail Planning and Tracking Site
Roche and/or Surround
Scanner (Handheld)
Security Incident Form
Tango Catalog Table
tbc.xmatters.com
Time Clock
TIPS-Reports-Dashboards
TIPS-SharePoint-Not Reports Related
Title 21 - Used for Occurrences
Title 21 - Used for SOPs (on TIPS)
Tobacco Affidavit
Trading Post
Trima Machine
Trima Scheduler 1.0
Unit Finder
Vista
Website thebloodconnection.org
Workplace (TBC Social Media)
Zebra Printer
Urgency*
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Low
High
Emergency
Issue Date*
Due Date*
Title*
Description*
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