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__
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__
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