Ultrasound Probe Storage End User Question Title * 1. Country Question Title * 2. Facility Question Title * 3. Product(s) Used Ultrasound Probe Storage Cabinet Transducer Storage Rack Question Title * 4. Item Number(s) Used Question Title * 5. Probe or Scope Types Endoscope General purpose probe Transvaginal probe Transrectal probe Transesophageal probe (TEE or TOE probe) Other (please specify) Question Title * 6. Probe Status During Storage Dirty Clean Low-Level Disinfected Intermediate-Level Disinfected High-Level Disinfected Sterilized Question Title * 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? Based on product design, how easy is it to monitor and replace the HEPA filter? 1-Most Difficult Based on product design, how easy is it to monitor and replace the HEPA filter? 2 Based on product design, how easy is it to monitor and replace the HEPA filter? 3 Based on product design, how easy is it to monitor and replace the HEPA filter? 4 Based on product design, how easy is it to monitor and replace the HEPA filter? 5-Easiest/Least Difficult Comment Based on product design, how easy is it to safely store your probe? Based on product design, how easy is it to safely store your probe? 1-Most Difficult Based on product design, how easy is it to safely store your probe? 2 Based on product design, how easy is it to safely store your probe? 3 Based on product design, how easy is it to safely store your probe? 4 Based on product design, how easy is it to safely store your probe? 5-Easiest/Least Difficult Comment Question Title * 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? How satisfied are you with the quality of this product? 1-Low Satisfaction How satisfied are you with the quality of this product? 2 How satisfied are you with the quality of this product? 3 How satisfied are you with the quality of this product? 4 How satisfied are you with the quality of this product? 5-High Satisfaction Comment In your opinion, how well does the system protect the probe from contamination? In your opinion, how well does the system protect the probe from contamination? 1-Low Satisfaction In your opinion, how well does the system protect the probe from contamination? 2 In your opinion, how well does the system protect the probe from contamination? 3 In your opinion, how well does the system protect the probe from contamination? 4 In your opinion, how well does the system protect the probe from contamination? 5-High Satisfaction Comment In your opinion, how well does the storage system protect the probe from damage? In your opinion, how well does the storage system protect the probe from damage? 1-Low Satisfaction In your opinion, how well does the storage system protect the probe from damage? 2 In your opinion, how well does the storage system protect the probe from damage? 3 In your opinion, how well does the storage system protect the probe from damage? 4 In your opinion, how well does the storage system protect the probe from damage? 5-High Satisfaction Comment Question Title * 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 Question Title * 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 Question Title * 11. Please provide your email address in order for CIVCO to respond to any concerns. Done
