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:
5. Minor__     B. Minor__     C. Minor__     D. Trivial__

 

5. Nature of the problem:
6. 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__ No