Data Entry Form

Our primary service is to collect survey responses from individual participants. However, some organizations have groups of employees that work in the field without internet access. These organizations may have groups of employees that require a printed questionnaire form that needs to be "keyed" in using a data-entry form. We can facilitate this process through forms developed specifically for data entry through the numeric keypad of the keyboard.

The is not a typical process for on-line surveys. But if your project needs a data-entry form, we can provide one for you specifically for this purpose.

Data Entry: This is an example of a data entry form that could be used to "key-in" responses efficiently using the numeric keypad on the computer. This data entry form is not intended to be accessed by individual participants.

Please submit this survey by Friday the 3rd.

Thank you again for your participation.

Please complete the items below and press the "Submit" button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Skip any items you do not wish to answer. Keep in mind your responses help us to become a better place to work. So, you are encouraged to respond to all items.

Number of years with the Company:
Less than 3 months
3 months to 1 year
1 year
2 years
3 years
4 years
5+ years

Name (Optional):

    Please indicate your level of satisfaction with each of the following statements. Enter a numeric response from 1 to 5. The computer will automatically advance to the next field as soon as you make a rating.

  1. Workload
  2. Flexibility of work hours
  3. Physical working environment
  4. Job security
  5. Access to company-sponsored training and seminars
  6. Your relationship with your peers
    : What is your suggestion on how to improve this number or any
    additional comments regarding this topic?

  7. Communication with your supervisor
  8. Recognition received from your supervisor
  9. Your supervisor's management capabilities
  10. Your overall relationship with your supervisor
  11. Effectively leads the department
  12. Communicates well with drivers
  13. Has good leadership qualities
    : What is your suggestion on how to improve this number or any
    additional comments regarding this topic?

  14. Communicates well with drivers
  15. Relays information in a timely fashion
  16. Can be reached when needed
  17. Able to solve problems
  18. Understands driver issues
    : What is your suggestion on how to improve this number or any
    additional comments regarding this topic?

  19. How satisfied are you with the new pay package?
    Very Satisfied
    Somewhat Satisfied
    Somewhat Dissatisfied
    Very Dissatisfied

  20. Do you understand how the new pay package works?

  21. Have you been able to get answers to your questions about the new pay package?
    If so, from whom?

  22. Do you have any questions in regards to the new pay package?
    Please list any questions or comments about the new pay package:

  23. Would you refer others who are seeking employment to [Company]?
    Please provide explanation:

  24. Compared to a year ago how would you describe your current job satisfaction level with [Company] and why?
    -Very Satisfied
    -Somewhat Satisfied
    -Somewhat Dissatisfied
    -Very Dissatisfied

    Final Comment: