SMO-2017-1853/科伦A166项目-CUSTOMER FEEDBACK SURVEY - 问卷调查调研模板

Q1:Thank you for giving us the opportunity to work with you.To help us evaluate our quality in procedures and staff performance, we would very much appreciate your opinion and suggestions to improve customer satisfaction and to ensure your continuous support.Thank you for taking a few minutes to complete this survey.

注：如您与我们合作项目，对接多个CRC，麻烦请另填写一份，谢谢！

项目编号（SMO与申办方项目编号）： SMO-2017-1853/科伦A166项目

合作期间：2022.04.01至今

申办方：科伦

Q2:1、您的姓名：

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Q3:2、与您合作该项目CRC的姓名：

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Q4:3、Survey conducted date:

2022.6.7

2022.6.8

2022.6.9

2022.6.10

2022.6.11

2022.6.12

2022.6.13

2022.614

2022.6.15

2022.6.16

2022.6.17

2022.6.18

Q5:4、Data Entry/ Query Resolving Timeliness

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q6:5、Data Entry/ Query Resolving Completeness

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q7:6、Data Entry/ Query Resolving Accuracy

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q8:7、IVRS/IWRS Timeliness

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q9:8、IVRS/IWRS Completeness

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q10:9、IVRS/IWRS Accuracy

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q11:10、Drug Management Drug Re-order

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q12:11、Drug Accountability

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q13:12、Drug Dispensing/ Return

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q14:13、Related Forms Completion

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q15:14、Study File

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q16:15、Study Supplies

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q17:16、Laboratories Sample collection handle/storage/transmittal per protocol

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q18:17、Laboratories related forms maintenance

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q19:18、Laboratory kits

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q20:19、Source Management

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q21:20、Financial/ Budgetary Issues

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q22:21、Study Understanding

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q23:22、Soft Skill Ability to understand customer needs

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q24:23、Soft Skill Easily contacted/reached

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q25:24、 Soft Skill Response to client enquiries in a timely manner

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q26:25、 Soft Skill Build good relationship with study team

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q27:26、 Soft Skill Willingness to work together

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q28:27、Proactive ability Ability to solve problems to cope with unexpected situations in a timely manner

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q29:28、Proactive ability Identify risks and come up with solutions

Unsatisfactory

Acceptable

Satisfactory

Very Satisfactory

N/A

Q30:29、Overall evaluation：If 100 is full score, please give CRC an estimated score for the past 3 monthsfor this study:

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Q31:30、Please add any comments and suggestions

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