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  
• I wasn't able to open the internet/web-browser
• The TP-LINK/router didn't work
  
• I was able to get to the website, but then I didn't see my distribution 
• I was able to get to the website and see the distribution, but then was unable to enter data
• 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 DLS form
• Some on the tablet, and some on the paper DLS form
• Some on the tablet, and some on an extra piece of paper
• Other: ___________

While on distribution, how often were you able to synchronize the distribution data that was entered on the tablet:

• Every day
• About every other day
• Once or twice while out on a distribution
• I synchronized when I got back to the provincial office
• I didn't enter any data on the tablet

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

How does the tablet compare with the paper DLS form in terms of how much time in takes you to collect data for a facility?

• It takes about 30 minutes or more less to collect the data with the tablet
• It takes about 15 minutes less to collect the data with the tablet
• Using the tablet or the paper DLS form take roughly the same amount of time to collect the data
• It takes about 15 minutes longer to collect the data with the tablet
• It takes 30 minutes or more longer to collect the data with the tablet
• Other: ______________________________

The best things about using the tablet are:

1.

2.

3.

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 DLS form and then entering it on the computer later