InfoPoll Sample: Facility Survey

Sample - Facilities Survey

ABC Company

Section 1

1.1

How would you rate our facility in the followings?

	Excellent	Very Good	Good	Fair	Poor
Overall:
The lighting:
The overall cleanliness:
The cleanliness of rest rooms:

1.2

How would you rate the temperature control in the facility?

Always too hot
Sometimes too hot
Just right
Sometimes too cold
Always too cold

1.3

How would you rate the number of rest rooms in the facility?

Enough
Not enough

Section 2

2.1

What do you like least about our facility?

2.2

What do you like most about our facility?

2.3

What is your gender?

Male
Female

Section 3

3.1

Please provide your contact information (Optional)

Name:
Phone:

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