Basic Information
Name:
Distribution Month:
Distribution Dates:
Date Survey Completed:
Number of Facilities Visited:
Of the facilities you visited this month, for how many were you able to enter all the distribution data directly on the tablet while you were at the facility?
- All the facilities
- Most of the facilities
- About half of the facilities
- Less than half
- None
If you were not able to enter the distribution data directly on the tablet, what prevented you from doing so:
- Tablet was out of battery
- Website wasn’t working
- Not enough time to use the tablet
- The tablet was too hard to use
- Other problem with the tablet: ____________________
If you were not able to enter the distribution data directly on the tablet, how did you collect the facility visit information:
- All on the paper form
- Some on the tablet, some on the paper form
- Some on the tablet, some on an extra piece of paper
- Other: ___________
While on distribution, how often were you able to synchronize the distribution data:
- Every day
- About every other day
- Once or twice
- I didn’t synchronize until I got back to the provincial office
If you didn’t synchronize every day, why?
- No internet access
- Tried to synchronize but it didn’t work
- I forgot
- Other: ___________
How often did you charge the tablet?
- Always while driving
- Every day
- Every other day
- Less than every other day
Did the tablet ever run out of battery?
- Yes
- No
The facility visits took more time while using the tablet
- Yes
- No
How much longer did it take you to use the tablet versus writing the information on the paper DLS form:
- About an hour more
- About 30 minutes more
- About 15 minute more
- About 10 minutes more
- About 5 minutes more
The most difficult things about using the tablet are:
1.
2.
3.
Now that I’ve tried using the tablet, my preference would be to:
- Keep using the tablet
- Go back to writing the data on paper and then entering it on the computer later