Real-Time Simulation Feedback Form
Share your feedback on the simulation session to help us improve future experiences.
Participant Name
*
First Name
Last Name
Email Address
*
example@example.com
Simulation Title or Scenario Name
*
Date of Simulation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Role during the Simulation
*
Please Select
Observer
Participant
Facilitator
Evaluator
Other
Please rate the following aspects of the simulation:
*
Rows
Poor
Fair
Good
Very Good
Excellent
Realism of the scenario
1
2
3
4
5
Clarity of objectives
6
7
8
9
10
Engagement level
11
12
13
14
15
Facilitation quality
16
17
18
19
20
Technical performance
21
22
23
24
25
How would you rate your overall experience?
*
1
2
3
4
5
What aspects of the simulation were most effective?
What aspects of the simulation could be improved?
Did you encounter any technical issues during the simulation?
No issues
Minor issues (did not affect participation)
Major issues (affected participation)
Other
Would you recommend this simulation to others?
*
Yes
No
Additional comments or suggestions
Submit Feedback
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