Name:

Age:
Check the box that corresponds to your answer. Use the legend as your guide.

LEGEND: 5 – HIGHLY ACCEPTABLE 4 – ACCEPTABLE 3 – MODERATELY

ACCEPTABLE 2 – FAIRLY ACCEPTABLE 1 – NOT ACCEPTABLE

5 4 3 2 1
Functionality
1. Accuracy of the machine
2. Speed of operation
Durability
1. Ability to work for a long period of time.
Security
1. Environmental Safety
2. No harmful effect to the user
Performance
1. Is the machine segregates accordingly and
automatically?

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Respondent’s Signature