Perceptible Information Collection Form
Help us assess how clearly information is presented and perceived in various settings.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
What is your primary role or relationship to the environment/product being evaluated?
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Please Select
User/Customer
Staff/Employee
Visitor/Guest
Other
Please rate the overall clarity of the information provided.
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1
2
3
4
5
How easy is it to detect or notice important information in this environment/product?
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Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
Which formats are used to present information here? (Select all that apply)
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Visual (signs, labels, displays)
Auditory (announcements, alarms)
Tactile (Braille, raised symbols)
Other
Please rate the effectiveness of each information format in conveying key messages.
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Rows
Very Ineffective
Ineffective
Neutral
Effective
Very Effective
Visual (signs, labels, displays)
1
2
3
4
5
Auditory (announcements, alarms)
6
7
8
9
10
Tactile (Braille, raised symbols)
11
12
13
14
15
Are there any barriers that make the information difficult to perceive?
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Yes
No
If yes, please describe the barriers you encountered.
How would you suggest improving the perceptibility of information in this environment/product?
Please indicate the environment or product you are evaluating (e.g., building, website, device).
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