Ultrasound Probe Storage End User
*
1.
Country
(Required.)
2.
Facility
*
3.
Product(s) Used
(Required.)
Ultrasound Probe Storage Cabinet
Transducer Storage Rack
4.
Item Number(s) Used
*
5.
Probe or Scope Types
(Required.)
Endoscope
General purpose probe
Transvaginal probe
Transrectal probe
Transesophageal probe (TEE or TOE probe)
Other (please specify)
*
6.
Probe Status During Storage
(Required.)
Dirty
Clean
Low-Level Disinfected
Intermediate-Level Disinfected
High-Level Disinfected
Sterilized
7.
Rate ease of use on a scale of 1 to 5 (1 being the most difficult & 5 being the easiest or least difficult)
1-Most Difficult
2
3
4
5-Easiest/Least Difficult
Based on product design, how easy is it to monitor and replace the HEPA filter?
1-Most Difficult
2
3
4
5-Easiest/Least Difficult
Comment
Based on product design, how easy is it to safely store your probe?
1-Most Difficult
2
3
4
5-Easiest/Least Difficult
Comment
8.
Rate satisfaction on a scale of 1 to 5 (1 being the lowest level of satisfaction & 5 being the highest level of satisfaction)
1-Low Satisfaction
2
3
4
5-High Satisfaction
How satisfied are you with the quality of this product?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
In your opinion, how well does the system protect the probe from contamination?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
In your opinion, how well does the storage system protect the probe from damage?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
9.
Based on your clinical expertise, do you believe there is added contamination risk associated with the use of this storage system?
No
Yes (if yes, please explain in Comment box below)
Comment
10.
Based on your clinical expertise, do you believe there is an added risk of probe damage associated with the use of the storage system?
No
Yes (if yes, please explain in Comment box below)
Comment
11.
Please provide your email address in order for CIVCO to respond to any concerns.
