Survey Questions_2021

OMB Control #0693-0083
Expires 11/30/2021

Survey Questions (pg 1)
Exoskeleton Study

Version 14Mar2019

Subject # ________

Pre-Test

Before performing the test, have you had any previous injuries or do you have any
current pain, soreness or discomfort that may affect how you perform the test? Please
write the number(s) and mark the severity or write “none”.

A. What is your age, height, handedness, job title, and hobbies/sports?:
age: ___ height: _____ handedness: _____ job title: __________________________
physical hobbies/sports: ____________________________ how often: ___________

B. On a scale from 0 (low) - 5 (high), what is your daily activity level:
0
sedentary

1

NIST APPROVED
IRB NUMBER: EL-2018-0060
IRB APPROVAL DATE: 02/09/2021
IRB EXPIRATION DATE: 02/08/2022

2

3

4

5
highly active

Survey Questions (pg 2)
Exoskeleton Study

Test Preparation

1. On a scale from 0 - 5 (no effort – extreme effort), I found that to put on the exoskeleton
included:
0
No Effort

1

2

3

4

5
Extreme Effort

2. On a scale from 0 - 5 (uncomfortable - very comfortable), I found that the exoskeleton was:
0
Uncomfortable

1

2

3

4

5
Very Comfortable

3. While initially wearing the exoskeleton, I found that my movements were:
0
Not
Obstructed

1

2

3

4

5
Obstructed

During the Test

4. When NOT wearing the exoskeleton and while performing the test, did you have any
pain, soreness or discomfort? Please mark accordingly.

NIST APPROVED
IRB NUMBER: EL-2018-0060
IRB APPROVAL DATE: 02/09/2021
IRB EXPIRATION DATE: 02/08/2022

Survey Questions (pg 3)
Exoskeleton Study

During the Test

5. When wearing the exoskeleton and while performing the test, did you have any pain,
soreness or discomfort? Please mark accordingly.

6. The exoskeleton provided ergonomic (efficient and comfortable) support
during the test.
0
1
2
3
4
5
N/A Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
7. While wearing the exoskeleton, it helped you complete the test?
0
1
2
3
4
5
N/A Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
8. The task you performed provided information about the usefulness of an
exoskeleton.
0
1
2
3
4
5
N/A Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
9. Which part of the test did the exoskeleton provide the most benefit?
0
1
2
3
4
N/A
floor
low wall
high wall ceiling
10. Which part of the test did the exoskeleton provide the least benefit?
0
1
2
3
4
N/A
floor
low wall
high wall ceiling

NIST APPROVED
IRB NUMBER: EL-2018-0060
IRB APPROVAL DATE: 02/09/2021
IRB EXPIRATION DATE: 02/08/2022

Survey Questions (pg 4)
Exoskeleton Study
11. Was the task you performed frustrating to you?
Yes
No

General Questions about the Test

12. What did you like most and least about wearing and using the exoskeleton?
Most liked: ____________________________________________________________
______________________________________________________________________
Least liked: ____________________________________________________________
______________________________________________________________________
13. Where did you feel the exoskeleton best supported your movements during the
task (knees, hips, back, shoulders, arms, etc.) ?
_______________________________________________________________________
_____________________________________________________________________
14. What were the easiest and most difficult parts of the exoskeleton test(s)?
Easiest: ______________________________________________________________
Most Difficult: _________________________________________________________
15. What would you change about the exoskeleton or the task you performed (use the
back of this page if more space is needed)?
_______________________________________________________________________
_______________________________________________________________________
16. The task sufficiently captured my maximum load and repetition without the
exoskeleton.
0
1
2
3
4
5
N/A Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
17. The task sufficiently captured my maximum load and repetition with the
exoskeleton.
0
1
2
3
4
5
N/A Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
18. The test properly represents the real world.
0
1
2
3
N/A Strongly Disagree
Disagree
Neutral

4
Agree

5
Strongly Agree

19. The task tested the limitations of the exoskeleton.
0
1
2
3
4
5
N/A Strongly Disagree Neutral Agree
Strongly
Disagree
Agree
20. The task tested the capabilities of the exoskeleton.
NIST APPROVED
0
1
2
3
4
5
IRB NUMBER: EL-2018-0060
Strongly
IRB APPROVAL DATE: 02/09/2021 N/A Strongly Disagree Neutral Agree
Disagree
Agree
IRB EXPIRATION DATE: 02/08/2022

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