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Customer Feedback on Products Class I
Customer Feedback on Products Class I
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Location and Contact
Hospital’s name
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City
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Surg Departement
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Country
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Surgeon’s name
Dealer
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Product group* (please check only one)
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Light Source
Products for cleaning and storage
Camera + TV Adapter
HF cables
Laryngoscope, Otoscope
item *
Reference
*
Description
*
The performance of the medical device is fully satisfying
*
Yes
No
Comments
The medical device can be well decontaminated
*
Yes
No
Comments
There are no incidents or other reportable events occurred
*
Yes
No
Comments
There are no user interruptions
*
Yes
No
Comments
There is no off-label use or misuse of the medical device
*
Yes
No
Comments
There are no (new) risks / hazards associated with the medical device
*
Yes
No
Comments
Are there other techniques replacing the product (state of the art) or other developments, e.g. in the area of workers safety or waste disposal?
*
Yes
No
Comments
How satisfied are you with the product?
*
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
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