Page 242 - QAP Manual 2020

Pre-Survey Background Section I Section II Surveyor
Form Info Feedback

Surveyor Feedback Sheet

Instructions

Please take a few minutes to complete a feedback sheet after each survey.
Please DO NOT INCLUDE any personally identifying information regarding yourself or the individual
surveyed (e.g., names, addresses, phone numbers, etc.).

Surveyor’s Initials or Code (optional) _____________________

1. How long did it take to complete the direct face-to-face survey(s) (Sections I and II only)?

___ ___ hours ___ ___ minutes

2. How long did it take to complete the entire form, including making phone calls, collecting
background information, arranging and conducting the face-to-face survey, travel time, etc.?
___ ___ hours ___ ___ minutes

3. Were there any questions that were problematic? (For example, questions that were difficult for
respondents to understand that may have required further explanation or clarification for the
respondent to answer)
___ Yes ___ No

If yes, indicate the question number(s) below and describe the problem and any suggestions you have
for improvement. Remember: Please DO NOT INCLUDE any personally identifying information
regarding yourself or the individual surveyed.

Question Problem/Suggestions

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