Checkbox Count Form
Use this form to specify a checkbox group, list available options, record counts, and provide context for interpreting checkbox selections.
Checkbox Group Name or Description
*
Purpose of Counting This Checkbox Group
*
List the Available Checkbox Options
*
How many checkboxes were available in total?
*
How many checkboxes were checked?
*
Date of Checkbox Count
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Person Responsible for the Count
Is the count complete or partial?
*
Complete
Partial
Method Used for Validation or Verification
Additional Notes or Comments
Submit
Should be Empty: