Hospital Technology Upgrade Evaluation Form
Provide your feedback on recent technology upgrades to help improve hospital operations.
Your Full Name
*
First Name
Last Name
Department
*
Please Select
Emergency
Intensive Care Unit (ICU)
Surgery
Radiology
Laboratory
Administration
Other
Your Role
*
Please Select
Physician
Nurse
Technician
Administrator
Support Staff
Other
Technology Name or Type
*
Area of Use (e.g., patient monitoring, diagnostics, administration)
*
Date of Technology Upgrade
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate the impact of this technology upgrade on your workflow?
*
Very Negative
1
2
3
4
Very Positive
5
1 is Very Negative, 5 is Very Positive
How would you rate the usability of the upgraded technology?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How reliable has the upgraded technology been?
*
Unreliable
1
2
3
4
Very Reliable
5
1 is Unreliable, 5 is Very Reliable
Was the training provided for the upgraded technology adequate?
*
Yes
No
Overall, how satisfied are you with the technology upgrade?
*
1
2
3
4
5
Additional comments or suggestions
Submit Evaluation
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