Computer Problem Report Form

Your Name: ________________________________ Your Login Name: __________________

The date? ____/____/____ The date the problem first occurred if different? ____/____/____


Describe your problem:
__________________________________________________________________________

Now, describe the problem accurately:
__________________________________________________________________________

Speculate wildly about the cause of the problem:
__________________________________________________________________________


Problem Severity:


Nature of the problem:


Is your computer plugged in? Yes____ No____
Is it turned on? Yes____ No____ Have you tried to fix it yourself? Yes____ No___
Have you made it worse? Yes____ No___
Have you read the manual? Yes____ No___
Are you sure you've read the manual? Yes____ No___
Are you absolutely certain you've read the manual? Yes____ No___
Do you think you understood it? Yes____ No___


If 'Yes' then why can't you fix the problem yourself?
__________________________________________________________________________

How tall are you? Are you above this line?
__________________________________________________________________________

Is the equipment unexpectedly noisy? Yes____ No___

If "Yes," what sort of noise?
  • Grinding
  • Rattling
  • Whirring

High Pitched Whine
  • Sound of disk head scouring disk
  • Strange, out of tune whistling or humming

Is there a smell of burning? Yes____ No___
If "Yes," is the equipment on fire? Yes____ No___
Is the fault repeatable? Yes____ No___


What were you doing with your computer at the time the problem occurred?
__________________________________________________________________________

If "nothing" explain why you were logged in.
__________________________________________________________________________


Are you sure you aren't imagining the problem? Yes____ No___


How does this problem make you feel?
__________________________________________________________________________

Tell me about your childhood.
__________________________________________________________________________


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


Which are appears to be at fault?
  • Communications
  • Disk
  • Base Unit
  • Network
  • Keyboard
  • Screen
  • Mouse
  • Everything
  • Don't Know

Can't you do something else, instead of bothering me? Yes____No____