QUESTIONNAIRE ON ELECTRICITY USAGE

You are invited to respond to each question in the following questionnaire. It is estimated that the questions should take approximately <xxx> minutes to complete. A spontaneous response is the best outcome. Would you please record your response in the following questionnaire and “submit” the questionnaire to Phacelift by selecting that button at the end of the document.

Your detailed response to this questionnaire will be held in strict confidence by Phacelift. Phacelift will analyse the responses and aggregate data, without divulging the respondee, to provide overall trends and performance results.

The aggregated results of the survey will be emailed to you for information.

Instructions for completing the Questionnaire

Please complete the following questions by placing a circle around each relevant response, or a circle around the percentage in the scale of 0% to 100%. Where possible, please respond to all questions. A blank response will imply that the question was not applicable.

Scale Markers

In many questions, the scale markers are graded from ‘NO’ (0%) to YES (100%). Where appropriate, please substitute NEVER for NO and ALWAYS for YES, and apply the percentage scale accordingly.

Tense of questionnaire

The questions have been presented in the ‘present tense’ for style consistency. Please also read the questions in the past tense if this is more appropriate to your experience:

Close of questionnaire

Please “submit” the questionnaire response on or before CoB on <date>.

A. BACKGROUND QUESTIONS

 
Group 1: Are you a:          
(a) Male and 18 years old or older          
(b) Male and 17 years old or older          
(c) Female and 18 years old or older          
(d) Female and 17 years old or younger          
(e) A parent          
(f) A child          
               
               
Group 5: In reference to your interaction with <xxx> people, do you consider that their customer service practises:
  (pleases circle an appropriate percentage)   NO       YES
(a) Take your perspective into account?   0% 25% 50% 75% 100%
(b) Have integrity?   0% 25% 50% 75% 100%
(c) Are based on open communication?   0% 25% 50% 75% 100%
(d) Are competent?   0% 25% 50% 75% 100%
(e) Allow you access to appropriate levels of people within <xxx> to discuss matters of interest or concern?   0% 25% 50% 75% 100%
 
Your Email address:  
Your Full Name:
Tell me what you think of me?