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SwISTEM Equipment Lending Service Post Check-Out Evaluation
For future funding possibilities and service upgrades, it is very important that you complete the following brief survey after each equipment check-out period. Thank you for your time.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
School or Organization
*
Your answer
County
*
Your answer
Date of Equipment Check-out
*
When was the equipment delivered?
Your answer
Grade Level/Subject Matter
*
What grade level and/or subject matter was taught using the equipment? Check all that apply.
Pre-K
K-1
2-3
4-5
6-8
9-10
11-12
Life Science
Physical Science
Earth/Space Science
Chemistry
General Mathematics
Algebra
Geometry
Calculus
Engineering
Technology
Homeschool
Other:
Required
Equipment Type
*
Please select the type of equipment you checked out from the Equipment Lending Service. Check all that apply.
Vernier LabQuest Handheld Interfaces
Vernier Probes
Microscope and/or Dissecting Scope Equipment
Electrostatic Generator
General Laboratory Equipment (Balances, Scoopulas, Forceps, Goggles, Beakers, etc.)
Laptops
Earth Science Equipment (Rocks, Minerals, Magnets, etc.)
Physical Science Equipment (Dynamics Tracks, Electricity Kits, Sine Wave Generators, etc.)
Gel Electrophoresis Equipment
Spectrophotometers (Spec 20's)
Chemistry Model Sets
Calculators
Mathematics Manipulatives/Resources
Human Skeleton Model
Other:
Required
Student Impact
*
Approximately, how many students used the equipment during this check-out period?
Your answer
Reservation Process
*
Please rate the reservation process of the equipment.
Very Inconvenient
1
2
3
4
5
Very Convenient
Delivery Process
*
Please rate the delivery process of the equipment.
Poor
1
2
3
4
5
Excellent
Retrieval Process
*
Please rate the pick-up process of the equipment.
Poor
1
2
3
4
5
Excellent
Equipment Quality
*
Please rate the quality of the equipment.
Poor
1
2
3
4
5
Excellent
Equipment Availability
*
Were you able to reserve the equipment for the date you wished to use it?
Yes, I was able to receive the equipment on date I requested.
I was able to receive the equipment I requested but had to alter the receipt date.
No, I was unable to reserve the equipment.
Other:
Required
Equipment Difficulties
Please indicate any problems or difficulties you encountered with the equipment. (Broken, Damaged, Missing Parts, etc.)
Your answer
Other Comments
Questions, Concerns, Needs, Etc.
Your answer
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