Basic information of respondent |
Name:
Age:
Identity: patient / family member of patient
Telephone:
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Questions |
1. Is the Passageway crowed? A yes B no C indifferent
2. Which one will you choose if you want to use lift or stairway (according to service desk)? A the left B the middle C the right
3. Is it convenient if you want to air clothes in hospital? A yes B no C indifferent
4. Do you feel it is a trouble if anyone has a rest or smoking in stairway? A yes B no C indifferent
5. Is it convenient that the restroom and drinking-water supplying system shared same area? A yes B no C indifferent
6. Is visual guide efficient to remind exit way in stairway? A yes B no C indifferent
7. Is visual guide efficient to remind slipping in passageway? A yes B no C indifferent
8. Is visual guide efficient to remind correct use of fire hydrant, extinguisher, and alarm? A yes B no C indifferent
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Other advice or suggestion |
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