This is a form to make the reporting of problems consistent, allow records of problems to be kept, and a method of discouraging users from reporting faults in the first place.

1. Your Name: __________________________
2. Your Login Name: ____________________
3. The date? __/__/__
4. The date the problem first occurred if different? __/__/__
5. Problem severity:
Minor ___ Minor ___ Minor ___ Minor ___
6. Which machine?
7. What appears to be at fault?
Communications ___ Disk ___ Base Unit ___
Network ___ Keyboard ___ Screen ___
Mouse ___ Everything ___ Don't Know ___
8. Is it plugged in? Yes___ No ___
9. Is it switched on? Yes___ No ___
10. Has it been stolen? Yes___ No ___
11. Have you tried to fix it yourself? Yes___ No ___
12. Have you made it worse? Yes___ No ___
13. Have you read the manual? Yes___ No ___
14. Are you sure you've read the manual? Yes___ No ___
15. Are you absolutely certain you've read the manual? Yes___ No ___
16. Did you understand it? Yes___ No ___
17. If 'Yes", then why can't you fix it yourself?______________________
18. Is the equipment unexpectedly noisy? Yes___ No ___
19. 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 ___
20. Is there a smell of burning? Yes___ No ___
21. If "Yes", is the equipment on fire? Yes___ No ___
22. Is the fault repeatable? Yes___ No ___
23. What were you doing (with the equipment) at the time the fault occurred?
______________________________________________________________
______________________________________________________________
24. If 'Nothing', explain why you were logged in.
______________________________________________________________
25. Do you have any independent witnesses of the problem?
Yes___ No ___
26. Describe the problem _________________________________________
______________________________________________________________
27. Now, describe the problem accurately _________________________
______________________________________________________________
28. Speculate wildly about the cause of the problem ______________
______________________________________________________________
______________________________________________________________
29. Can't you do something else, rather than bothering me?
Yes___ No ___