Self-Checkout Instructions Form
Please review the self-checkout process, confirm your understanding, and provide feedback to help us improve our service.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Please provide your phone number in case we need to contact you regarding your self-checkout experience.
Please enter a valid phone number.
Format: (000) 000-0000.
Self-Checkout Process Overview
Step-by-Step Instructions for Self-Checkout:
1. Scan your items using the barcode scanner.
2. Place scanned items in the bagging area.
3. If you have coupons, scan them before proceeding to payment.
4. Select your payment method and follow on-screen prompts.
5. Collect your receipt and bagged items before leaving.
Did you find the self-checkout instructions clear and easy to follow?
*
Very clear
Somewhat clear
Neutral
Somewhat unclear
Very unclear
Please rate your overall experience using the self-checkout process.
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1
2
3
4
5
Which step(s) of the self-checkout process did you find most challenging? (Select all that apply)
Scanning items
Bagging items
Applying coupons
Selecting payment method
Other
How confident are you in completing a self-checkout transaction on your own in the future?
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Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Please provide any suggestions or comments to help us improve the self-checkout instructions or process.
Please sign below to confirm your acknowledgment.
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