Pilot Issues Form
Page 1
Date:
Agency/Clinic #’s:
Staff Name:
Machine:
Laptop or Desktop
Complete the Following Participant (PPT) Information (all applicable information):
State WIC ID #:
Household ID #:
WIC Status:
DOB
Height
Weight
BF Amount
Infant Birth
Weight
Cert Start
Date
LDTU
Converted
PPT?
FDTU
P
N B C I
YES
NO
Did an error message appear (Print screen shots if possible)?
Error #:
Error Description:
Circle One (If Applicable):
Kicked Out of HuBERT
Computer Locked Up
OK’d and Continued
In What Part of HuBERT Did the Issue Occur? Circle One.
PPT Search
PPT List
PPT Folder
Guided Script
Reports
Appointment Scheduling
Other: __________________________________________
In What Screen Did the Issue Occur? Circle One.
Pre-Screen
Income Eligibility
Certification Risk Codes
Benefit Issuance
Demographics
Height/Weight
Update Risk Codes
Benefit History
Food Package
Blood
Health Information/History
Appointments
Notes
Alerts
Parent/Guardian/Proxy
Daily Appointments
Other: __________________________________________
Did you call the Help Desk?
Yes/No
If you called the Help Desk, what was the Magic Ticket #? _________________________
STATE USE ONLY
Type:
Bug
Training
JIRA Number: _____________
Enhancement
Recreated by:
________________________
Defect Severity: ________________________
Pilot Issues Form
Page 2
Describe (in Detail) the Issue and Any Steps Beforehand (Helps to Recreate the Issue):
Provide as much detail as possible to let another person know how you got to the point of the issue so they can recreate
and let the development team know what to fix. This detail helps the issues get prioritized faster!
Please attach screen shots if possible.
STATE USE ONLY
Type:
Bug
Training
JIRA Number: _____________
Enhancement
Recreated by:
________________________
Defect Severity: ________________________