*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__
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__