Terminal Reporting Survey
Please complete this survey to report on terminal operations, performance, and any issues encountered.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Terminal ID or Number
*
Terminal Location (City/Area)
*
Your Role or Position
*
Please Select
Operator
Supervisor
Technician
Manager
Other
Date of Report
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Terminal Operational Status
*
Fully Operational
Partially Operational
Out of Service
Rate the following aspects of the terminal:
*
Rows
Excellent
Good
Average
Poor
N/A
Cleanliness
1
2
3
4
5
Functionality of Equipment
6
7
8
9
10
User Interface
11
12
13
14
15
Security Features
16
17
18
19
20
Customer Support
21
22
23
24
25
Were any technical issues encountered?
*
No issues
Minor issues (did not affect operation)
Major issues (affected operation)
If issues occurred, please describe them (optional)
Rate your overall satisfaction with the terminal
*
1
2
3
4
5
Suggestions for improvement or additional comments (optional)
Submit Report
Should be Empty: