I.T. DEPARTMENT COMPUTER PROBLEM SELF-REPORT FORM

1. Describe your problem: ______________________________

2. Now, describe your problem accurately: _________________

3. Speculate wildly about the cause of the problem: __________

4. Problem Severity:
A. Minor__ B. Minor__ C. Minor__ D. Trivial__

5. Nature of the problem:
A. Locked Up__ B. Frozen__ C. Hung__ D. Shot__

6. Is your computer plugged in? Yes__ No__

7. Is it turned on? Yes__ No__

8. Have you tried to fix it yourself? Yes__ No__

9. Have you made it worse? Yes__

10. Have you read the manual? Yes__ No__
Z
11. Are you sure you've read the manual? Yes__ No__

12. Are you absolutely certain you've read the manual? No__

13. Do you think you understood it? Yes__ No__

14. If `Yes,' then why can't you fix the problem yourself?____________

15. How tall are you? Are you above this line? ___________________

16. What were you doing with your computer at the time the problem occurred?
________________________________

17. If `nothing,' explain why you were logged in: ___________________

18. Are you sure you aren't imagining the problem? Yes__ No__

19. How does this problem make you feel? _______________________

20. Tell me about your childhood: _______________________________

21. Do you have any independent witnesses of the problem? Yes__ No__

22. Can't you do something else, instead of bothering me? Yes__