REV. 1.21.

A OFFICIAL USE ONLY

Problem Report
Please answer the following questions in fifty works or less. When you have completed
all questions, submit the form to your representative and allow ten working days for
processing. Additional information on the reverse..

1. Describe the problem:

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2. Who is the outsider and what is their role?

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3. What business am I in?

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4. How badly do I want it?

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5. Where?
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6. What role do I fill?

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7. What are the major unpredictable elements?

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8. What have I assumed?

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9. Who might be feeling bad about me?

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10. What has not occurred to me?

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REV. 1.21.A OFFICIAL USE ONLY

Additional Information
 The structure is the space in between the notes.

 You can tell the same story with a tennis rackets as with a sword.

 Deal with every situation as though you created it.

 Control is an illusion.

 Use your adversary’s strength.

 There are no accidents.

 Always remember how lucky you are to have gotten this, how you really do not
deserve it and how you get so many things you do not deserve.

 You drive where you are looking.

 Respect decisions that have been made.

 If I win and you loses, we both lose.

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Name Date

For Office Use Only Date:

Examiner: Approved by: Disposition:

 Referral
 Defer
 Inactive
Comments:
REV. 1.21.A OFFICIAL USE ONLY