Remote Worker Diagnostic Evaluation Consent
Provide your details and consent to participate in the remote work diagnostic evaluation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Job Title / Role
*
Department / Team
How would you rate your current remote work setup in the following areas?
*
Rows
Excellent
Good
Fair
Poor
Internet Connectivity
1
2
3
4
Access to Necessary Software
5
6
7
8
Workstation Ergonomics
9
10
11
12
Communication with Team
13
14
15
16
Which of the following equipment do you currently use for remote work? (Select all that apply)
*
Company Laptop
Personal Computer
Headset / Microphone
External Monitor
Other
How satisfied are you with your current productivity while working remotely?
*
Not satisfied
1
2
3
4
Extremely satisfied
5
1 is Not satisfied, 5 is Extremely satisfied
How often do you experience challenges with remote work?
*
Daily
Several times a week
Rarely
Never
Please describe any specific challenges or support you need to improve your remote work experience.
Signature
*
Submit Evaluation
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