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Computer Problem Self-report Form1. Describe your problem:____________________________________________ 2. Now, describe your problem accurately: ___________________________________________________________ ___________________________________________________________ 3. Speculate wildly about the cause of the problem: _________________________________________________________________ _________________________________________________________________ 4. Problem Severity:
A. Minor__ 5. Nature of the problem:
A. Locked Up__ 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__
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