AI Assistant Survey Template: Expectations & Escalation

Collect feedback on AI assistant expectations, human escalation, and control preferences. Customize this free survey template to boost trust, satisfaction, UX.

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Intelligent follow-up questions based on responses

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Sample Survey Items

Multiple Choice

In the past 30 days, how often have you used any AI assistant?

Daily
A few times a week
About once a week
A few times this month
None in the past 30 days
Never

Multiple Choice

Attention check: To confirm you are paying attention, please select “I am paying attention.”

I am paying attention
I am not sure
Skip this question
Prefer not to say

Matrix

How important are the following AI agent behaviors to you?

Rows	Not important	Slightly important	Moderately important	Very important	Essential
Provide sources or links for key claims	•	•	•	•	•
Acknowledge uncertainty when not confident	•	•	•	•	•
Ask for approval before executing actions	•	•	•	•	•
Follow explicit instructions	•	•	•	•	•
Suggest safer or lower-risk alternatives	•	•	•	•	•
Keep an audit trail of actions	•	•	•	•	•
Respect my organization’s policies	•	•	•	•	•

Rating

By default, how much autonomy should an AI agent have in your workflow?

Scale: 10 (star)

Min: No autonomyMax: Full autonomy

Multiple Choice

When the agent is unsure or detects risk, what should it do?

Escalate to a human when its confidence is low
Ask me to approve actions as needed
Continue autonomously unless I stop it

Multiple Choice

If escalation occurs, how should the handoff to a human happen?

Live chat with a human
Open a support ticket
Email a specialist
Phone call
Schedule a callback
Forward to my team or shared inbox

Numeric

What is the maximum single purchase amount (USD) you would allow an agent to make without your approval? Enter 0 if none.

Accepts a numeric value

Whole numbers only

Opinion Scale

During longer tasks, how frequently should the agent send status updates?

Range: 1 – 10

Min: NeverMid: OccasionallyMax: Very frequently

Multiple Choice

Which actions may the agent perform without asking first? (Select all that apply.)

Draft but do not send messages
Send emails to internal recipients
Schedule calendar events
Browse and read web pages
Access non-sensitive files
Run code in a sandbox
Create tickets or tasks
None of the above

Q10

Multiple Choice

What concerns, if any, do you have about AI agents? (Select all that apply.)

Privacy or data leakage
Inaccuracies (hallucinations)
Bias or unfair outcomes
Security vulnerabilities
Compliance or legal risk
Unexpected costs or overuse
None of the above

Q11

Multiple Choice

What is your age range?

18–24
25–34
35–44
45–54
55–64
65+
Prefer not to say

Q12

Multiple Choice

Where do you primarily live?

Africa
Asia
Europe
Latin America & Caribbean
Middle East
North America
Oceania
Prefer not to say

Q13

Multiple Choice

What is the highest level of education you have completed?

High school or equivalent
Some college or vocational training
Bachelor’s degree
Master’s degree
Doctorate
Prefer not to say

Q14

Multiple Choice

What is your current employment status?

Full-time
Part-time
Self-employed
Student
Not employed
Retired
Prefer not to say

Q15

Long Text

Is there anything else you’d like to share about your expectations, escalation preferences, or desired controls for AI agents?

Max 600 chars

Q16

AI Interview

AI Interview: 2 Follow-up Questions on AI agent experiences

AI InterviewLength: 2Personality: Expert InterviewerMode: Fast

Q17

Chat Message

Thanks for your time—your feedback will help improve AI agents for everyone.

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