Senior Safety Monitoring Device Assessment Questionnaire Form
Please complete this questionnaire to help us evaluate the use and effectiveness of the senior safety monitoring device.
How easy was it to set up the device?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How reliable do you find the device during daily use?
*
1
2
3
4
5
Please rate your overall satisfaction with the device.
*
1
2
3
4
5
To what extent do you agree with the following statements about the device?
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The device improves safety
1
2
3
4
5
The device is easy to maintain
6
7
8
9
10
The device provides timely alerts
11
12
13
14
15
How likely are you to recommend this device to others?
*
Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely, 10 is Extremely likely
What features do you find most useful? (Select all that apply)
Emergency alert button
Fall detection
Location tracking
Automatic notifications
Other
How frequently do you or the user interact with the device?
Multiple times a day
Once a day
A few times a week
Rarely
Have you experienced any technical issues with the device?
Yes
No
If you answered Yes above, please briefly describe the issue(s):
Please share any additional comments or suggestions.
Submit Assessment
Should be Empty: