I think there is a canned report that comes standard in Orion that is very similiar to what you are looking for. Under the Current Interface Status section in Reports, there is a report called Down Interfaces that displayes a list of all interfaces that are in a down or unknown status. The only column that it doesn't include is the last status change date and time. You can edit this report in report writer and add the
"Interface Last Change" from Interfaces, Interface Status in the Select Fields tab of the report.
Once you have the report edited to suit your needs, you can use the Orion Report Scheduler to set up a schedule to have the report automatically emailed out.
Let me know if this helps or if you need more detailed instructions.