Enclosure 6

Enclosure 6 2016 CT Satisfaction questionnaire.docx

Generic Clearance for Questionnaire Pretesting Research

Enclosure 6

OMB: 0607-0725

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Questionnaire for User interaction Satisfaction (QUIS)



Directions- Please circle the numbers that most appropriately reflect your impressions about using the Web Survey.



Terrible Wonderful

  1. Overall reaction to the Web Survey: 1 2 3 4 5 6 7 8 9 N/A



Illogical Logical

  1. Screen Layouts: 1 2 3 4 5 6 7 8 9 N/A



Inconsistent Consistent

  1. Use of terminology throughout the survey: 1 2 3 4 5 6 7 8 9 N/A



Inadequate Adequate

  1. Instructions displayed on the screens: 1 2 3 4 5 6 7 8 9 N/A



Confusing Clear

  1. Questions displayed on the screens: 1 2 3 4 5 6 7 8 9 N/A



Never Always

  1. Questions can be answered in a- 1 2 3 4 5 6 7 8 9 N/A

straight forward manner:



Confusing Clear

  1. Organization of questions, instructions - 1 2 3 4 5 6 7 8 9 N/A

and response categories in survey:

Difficult Easy

  1. Forward navigation: 1 2 3 4 5 6 7 8 9 N/A



Difficult Easy

  1. Overall experience of completing- 1 2 3 4 5 6 7 8 9 N/A

survey:



Difficult Easy

  1. Correcting your mistakes: 1 2 3 4 5 6 7 8 9 N/A



11. Reading Text

Extremely Somewhat Borderline Somewhat Extremely N/A

Difficult Difficult Easy Easy

1 2 3 4 5



12. Inputting text

Extremely Somewhat Borderline Somewhat Extremely N/A

Difficult Difficult Easy Easy

1 2 3 4 5





13. Clicking Links/Radio Buttons

Extremely Somewhat Borderline Somewhat Extremely N/A

Difficult Difficult Easy Easy

1 2 3 4 5



14. Zooming in or Out

Extremely Somewhat Borderline Somewhat Extremely N/A

Difficult Difficult Easy Easy

1 2 3 4 5

Additional Comments:

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AuthorMichelle Lemieux
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File Created2021-01-28

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