PRODUCT TRIAL FORM - Royal Children's Hospital
|Form 4.0 |Product Trial Form |
|Product | |
|Supplier | |
|Supplier contact | |
|Trial sponsor | |Contact No. | |
|Trial period | |
|Name of Evaluator | |
|Position | |
|Ward or Department | |Contact No. | |
Circle the appropriate answers
|How many times did you use this product? |0-5 |5-10 |>10 |
|Did you receive suitable instruction in the use of this product? |Yes |No |N/A |
|Would you require further education in the use of this product? |Yes |No |N/A |
Performance Measurement tool
|Rating |Description |
|5 |Exceptional A prestigious product of the highest quality Exceeds expectation Would love to use in my ward area |
|4 |Superior A desirable product of good quality Meets all expectations |
| |Would very much enjoy having this product used in my ward. |
|3 |Acceptable A functional product of sufficient quality Would be suitable for use Would be impartial to its use in my ward |
| |area |
|2 |Tolerable A bearable product of only just passable quality. Not my preferred product to use but would use if required |
|1 |Inferior A poor product of low grade quality. May not be suitable |
| |Would not like to use in my ward |
Please rate the following by circling the appropriate answers
Standard Criteria
|Presentation |5 |4 |3 |2 |1 |
|Clear & legible labelling; instructions are in English and easily understood | | | | | |
|Packaging performance & impact |5 |4 |3 |2 |1 |
|Is packaging robust to adequately protect product; packaging is removed easily to appropriately | | | | | |
|expose product | | | | | |
|Performance |5 |4 |3 |2 |1 |
|How does the device function during clinical application | | | | | |
|Compatibility |5 |4 |3 |2 |1 |
|Does the product fit with other products being used | | | | | |
|Disposal |5 |4 |3 |2 |1 |
|How easy was the device to dispose of safely & appropriately | | | | | |
Key Criteria
| |5 |4 |3 |2 |1 |
| |5 |4 |3 |2 |1 |
| |5 |4 |3 |2 |1 |
| |5 |4 |3 |2 |1 |
|What benefits do you see in selecting this product? |
| |
| |
|What problems, if any, were encountered during the use of this product? |
| |
| |
Would you recommend continued use of product? Yes No
Why/Why not?
| |
| |
| |
| |
|Any other comments? |
| |
| |
| |
| |
Declaration – Conflict of interest and confidentiality
I declare that I do not have a conflict of interest, affecting my objectivity in evaluating this product. I have no financial or other interest in any of the product suppliers being evaluated. I agree to keep all results and deliberations concerning this product confidential.
Signed:
Date :
Thankyou for your participation.
|office use only | |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- sample letter to company for product placement request
- justification and approval
- project initiation document template ohio higher ed
- product trial form royal children s hospital
- new customer engagement letter template
- new product project proposal
- production process and product release procedure
- sample beta test agreement and cover letter
- product design specification template
- project approval template
Related searches
- children s hospital pensacola fl
- children s hospital employee benefits
- orlando children s hospital disney
- arnold palmer children s hospital orlando
- children s hospital orlando
- arnold palmer children s hospital careers
- children s hospital neurosurgery
- arkansas children s hospital records request
- children s hospital release of information
- children s hospital weekly menu
- children s hospital cafeteria menu
- free product trial offers