User Accessibility Machine Feedback Survey Form
Please share your experience with the accessibility of the machine or device. Your feedback helps us improve accessibility for all users.
Which machine or device are you providing feedback on?
*
How often do you use this machine or device?
*
Daily
Weekly
Monthly
Rarely
Overall, how would you rate the accessibility of this machine or device?
*
1
2
3
4
5
Please rate the following aspects of accessibility:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Ease of physical access
1
2
3
4
5
Ease of use/interface
6
7
8
9
10
Clarity of instructions
11
12
13
14
15
Support for assistive technology
16
17
18
19
20
Availability of assistance
21
22
23
24
25
Did you encounter any barriers or difficulties when using the machine or device?
*
No barriers
Some minor barriers
Significant barriers
Not sure
If you encountered barriers, please describe them briefly.
How satisfied are you with the support or assistance available for using this machine or device?
1
2
3
4
5
What improvements would you suggest to enhance accessibility?
Would you recommend this machine or device to others who require accessible features?
*
Yes
No
Not sure
Any additional comments or feedback?
Submit Feedback
Should be Empty: