Status Change Report

Status Change Report

Is there any way to get report in following format:
 
SD# 1234
PERIOD    
From Date To Date STATUS
30/09/2013 10:07 PM 30/09/2013 10:10 PM Acknowledged
30/09/2013 10:07 PM 1/10/2013 20:10 In Progress
1/10/2013 21:07 1/10/2013 22:10 OnHold
1/10/2013 22:07 1/10/2013 22:24 Open
1/10/2013 20:07 7/10/2013 23:10 In Progress
7/10/2013 22:07 7/10/2013 22:34 OnHold

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