Q01
Message
All templatesProduct & UX
Assistive Technology Accessibility Experience Survey
Captures accessibility barriers and WCAG compliance gaps reported by assistive technology users during real digital product sessions. Designed for UX and accessibility teams seeking to prioritize remediation based on user-reported severity and impact.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
24 questions · ~11 min
Q02
Multiple Choice
Which type best describes the digital product you used most recently (within the past 14 days)?
- Website on laptop/desktop
- Website on phone/tablet browser
- Native mobile app (iOS/Android)
- Desktop application
- Other (please specify)
Q03
Multiple Choice
Which tasks did you attempt in that session? Select all that apply.
- Sign in or register
- Search or browse content
- Complete a form
- Purchase or checkout
- Upload or download files
- Watch or listen to media
- Change settings or preferences
- Contact support or chat
- Other (please specify)
Q04
Opinion Scale
How clear and legible was the content (text, links, visuals) in that session?
Scale: 1 – 7
Min:Not at all clearMax:Extremely clear
Q05
Multiple Choice
Which accessibility barriers, if any, did you encounter in that session? Select all that apply.
- Low text contrast
- Small or dense touch targets
- Missing or poor alt text
- No visible focus indicator
- Keyboard traps
- Unlabeled buttons or links
- Ambiguous or missing error messages
- Dynamic content not announced
- CAPTCHA without an accessible alternative
- Session timeouts too short
- Motion/animation cannot be reduced
- Other accessibility barrier
- None of the above
Q06
Ranking
Rank these areas by priority for improvement for you (drag to reorder; top = most important).
- Visual clarity (contrast, size)
- Keyboard/navigation reliability
- Labels and alternative text
- Error messages and guidance
- Announcements of dynamic changes
- Media accessibility (captions, transcripts)
Drag to rank
Q07
Long Text
If you could request one change to improve the accessibility of the product you used, what would it be?
Q08
Dropdown
What is your age group?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65+
- Prefer not to say
Q09
Message
Thank you for your time — your feedback will directly help improve accessibility for everyone. Your responses are confidential and will be used to prioritize accessibility improvements.
Q10
Multiple Choice
Which assistive technologies did you use during that session? Select all that apply.
- Screen reader
- Screen magnifier/zoom
- High contrast or custom colors
- Voice control/dictation
- Switch control
- Keyboard-only navigation
- Captions or transcripts
- Read-aloud (not a full screen reader)
- Alternative pointer (e.g., eye tracking, head mouse)
- Other assistive tech
- None of the above
Q11
Opinion Scale
How successfully did you complete your main task in that session?
Scale: 1 – 7
Min:Not completed at allMax:Completed with no difficulty
Q12
Opinion Scale
How easy or difficult was it to operate the interface using your assistive technology setup?
Scale: 1 – 7
Min:Extremely difficultMax:Extremely easy
Q13
Long Text
Briefly describe the most significant accessibility barrier you faced. Please include the page or feature if possible.
Q14
Opinion Scale
Overall, how would you rate the accessibility of that session?
Scale: 1 – 7
Min:Very poorMax:Excellent
Q15
AI Interview
Based on your responses in this survey, we'd like to understand your accessibility experience in more depth. Please share any additional context about the barriers you encountered or what an ideal accessible experience would look like for you.
Q16
Multiple Choice
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q17
Multiple Choice
Which devices do you primarily use with assistive technology? Select all that apply.
- Windows PC
- Mac
- Chromebook
- iPhone/iPad (iOS/iPadOS)
- Android phone/tablet
- Other
Q18
Opinion Scale
How well did the product communicate what was happening — including labels, instructions, error messages, and status updates?
Scale: 1 – 7
Min:Very poorlyMax:Very well
Q19
Opinion Scale
Overall, how much did accessibility barriers affect your ability to complete your goal?
Scale: 1 – 7
Min:No impact at allMax:Completely prevented completion
Q20
Long Text
What country or region are you based in?
Q21
Dropdown
Approximately how long have you regularly used assistive technologies?
- Less than 1 year
- 1–3 years
- 4–6 years
- 7–10 years
- More than 10 years
- Prefer not to say
Q22
Dropdown
What is the highest level of education you have completed?
- Less than high school
- High school or equivalent
- Some college or vocational training
- Bachelor's degree
- Graduate or professional degree
- Prefer not to say
Q23
Opinion Scale
In a typical month, how often do you use assistive technology for digital products?
Scale: 1 – 5
Min:RarelyMax:Daily or almost daily
Q24
Multiple Choice
What is your current employment status?
- Employed full-time
- Employed part-time
- Self-employed
- Student
- Unemployed
- Retired
- Prefer not to say
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Built specifically around assistive technology users' real sessions with digital products, not generic workplace or technology topics — covering device/AT type, task attempted, and barriers encountered
- Uses opinion-scale questions to quantify legibility, operability, communication clarity, and overall accessibility, paired with an open-text question for the single most significant barrier
- Includes a ranking question so respondents prioritize improvement areas themselves, directly supporting remediation prioritization by severity/impact
- Adds an AI follow-up interview after the structured questions to probe deeper into each respondent's accessibility experience, something static form builders cannot do
SurveySparrow
Workplace Accessibility Survey TemplateThis is a static, fielding-ready template focused on workplace/employee accessibility accommodations rather than digital product WCAG compliance or assistive-technology user experience. It's a reasonable comparison on the general accessibility topic but targets a different audience (employees generally, not AT users testing digital products). No mechanism for adaptive follow-up on reported barriers.
What it does well
- Ready-to-deploy survey template within an established survey platform
- Likely includes standard accessibility/accommodation question sets for HR/workplace use
- Part of a broader employee-experience template library
Where it falls short
- Static question set with no adaptive AI follow-up to probe reported barriers further
- Focused on workplace accommodations, not digital product/WCAG-specific accessibility gaps
- No per-response quality scoring or automated severity-based reporting
Jotform
600+ Technology SurveysThis is a broad category/listing page of generic technology survey templates rather than an accessibility- or assistive-technology-specific template. It's useful as a form-building starting point but requires significant customization to address WCAG compliance or AT-user barriers. No accessibility-specific question logic is evident.
What it does well
- Large library of technology-related templates to choose from
- Drag-and-drop form builder for quick customization
- Established platform with broad integration options
Where it falls short
- No accessibility- or assistive-technology-specific template in view; generic tech survey content
- Static forms with no adaptive AI interviewing to explore user-reported barriers
- No automated quality scoring or severity-based reporting for remediation prioritization
QuestionPro
Technology Survey Questions + Sample Questionnaire TemplateThis page functions more as a guide with sample technology survey questions than a ready-made accessibility-specific instrument. It covers general technology usage/satisfaction rather than assistive-technology barriers or WCAG gaps, so teams would need to build the accessibility-specific content themselves.
What it does well
- Sample question bank for general technology topics
- Backed by an established survey research platform
- Guidance-style content useful for question design ideas
Where it falls short
- Not an accessibility- or AT-specific template; requires substantial rebuilding for this use case
- No adaptive AI follow-up or voice interview capability for probing barriers
- No transparent prompt methodology or automated per-response severity scoring
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
Related templates
More studies from the same category.
Product & UX
Form & Checkout Abandonment Diagnostic Survey
Diagnoses why users abandon forms, signups, and checkout flows. Captures the specific step, blockers, and recovery levers to reduce drop-off and improve conversion rates.
View templateProduct & UX
A/B Experimentation Trust & Data Quality Assessment
An internal diagnostic survey for teams that run or consume A/B tests, measuring trust in experiment results, identifying sources of flakiness, and prioritizing process and tooling improvements.
View templateProduct & UX
New Product Concept Evaluation Survey
Measures consumer reactions to a new product concept across innovation perception, quality assessment, purchase intent, and feature priorities. Designed for pre-launch product testing with target consumers.
View templateProduct & UX
Graphic Design Request Intake & Creative Brief Survey
Captures a complete brief for an internal or client graphic design request — project type, goal, audience, brand constraints, and priority trade-offs — so designers stop guessing what 'good' looks like. An AI follow-up interview digs into the real goal behind the ask and surfaces conflicting stakeholder expectations before work begins.
View templateProduct & UX
Self-Service Checkout Usability & Friction Survey
Measures how easily shoppers scan, pay, and recover from errors at self-service checkout kiosks, and prioritizes which fixes matter most. An AI follow-up interview reconstructs exactly what happened during a recent frustrating attempt instead of relying on vague complaints. Built for retail UX and store operations teams.
View templateProduct & UX
Website Visitor Follow-Up Experience Survey
Captures what visitors came to your site to do, whether they succeeded, and where they got stuck — with an AI follow-up that reconstructs the actual browsing journey behind any failed or frustrating visit. Built for product, UX, and marketing teams who want more than a bounce-rate number.
View template