Instructions:

When you experience a computer problem, complete this form and return it to your system administrator or parole office.

1.	Describe your problem: ______________________________________________
2.	Now, describe the 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 bother me? Yes __ No __