Telecom Network Outage Incident Feedback Form
Full Name
Email Address
Contact Number
Incident Location
Date & Time of Outage
Affected Service(s)
Mobile Voice
Mobile Data
Fixed Line
Internet/DSL
Other
Approximate Duration of Outage
Impact of Outage
Satisfaction with Response/Resolution
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Additional Comments