scaled response – gather range of “values” (strongly disagree, somewhat disagree, neutral, somewhat agree, strongly agree
1. Have you had any of the following medical preventive tests/exams?
_____ mammogram (if a women)
_____ prostate exam (if a man)
_____ lung x-ray
_____ stress test
2. Do you currently smoke? _____ YES _____ NO
Please evaluate the following statement:
I understand the University’s code of conduct as it relates to plagiarism.
____ absolutely agree
____ somewhat agree
____ somewhat disagree
____ absolutely disagree
Important characteristics of good questionnaires
Plan a user-friendly format
Gather demographic data – age, gender, etc., when necessary.
Ensure ease of tabulation – Scantron forms
Ask well-phrased and unambiguous questions that can be answered
Develop for completeness – get all the data
Pilot test the instrument
Prepare a questionnaire (word processed on paper) that you utilized to gather the primary data for the formal report case.
The questionnaire will be inserted as an appendix at the end of your formal report.
Remember, you should include on the survey :
an introductory statement about the purpose of the survey,
a motivational reason why customers should take it, and
a reminder to participants that they are taking the survey anonymously.
You should NOT include on the survey:
Example Questionnaire ensure anonymity purpose of the survey Introductory Statement The purpose of this survey is to help management identify family issues that our employees experience that are related to job performance. Please respond to the following survey items by checking the appropriate response next to each question/item. Your responses are completely anonymous and will only be used to assess overall employee characteristics.