Escalation Request Form

Purpose: This document is used to formally initiate an escalation process for customer support issues that are unresolved, critical or require immediate attention due to business impact.

Requester Information

• Name: {requesterName}
• Department/Team: {department}
• Email: {email}
• Phone: {phone}

Customer Information

• Customer Name: {customerName}
• Account Number: {accountNumber}
• Priority Level: {priorityLevel}

Issue Details

Summary: {issueSummary}

Date Reported: {dateReported}

Issue Category: {issueCategory}

Description of Issue:

{issueDescription}

Steps Already Taken

{#stepsTaken}

• {step}

{/stepsTaken}

Expected Impact

Description of Business Impact:

{businessImpact}

Current Workaround (if any):

{workaround}

Escalation Justification

Reason for Escalation:

{escalationReason}

Attachments

{#attachments}

• {filename}

{/attachments}

Escalation Approver

• Name: {approverName}
• Position: {approverPosition}
• Approval Date: {approvalDate}

Additional Comments

{additionalComments}

{#isUrgent}

This escalation has been marked as urgent.

{/isUrgent}

{^isUrgent}

This escalation is not marked as urgent.

{/isUrgent}