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AI Safety Prompts & Refusal Messages Survey Template

Measure clarity and usefulness of AI safety prompts and refusal messages. Ready-made survey template with UX questions, ratings, and feedback.

What's Included

AI-Powered Questions

Intelligent follow-up questions based on responses

Automated Analysis

Real-time sentiment and insight detection

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Target the right audience automatically

Detailed Reports

Comprehensive insights and recommendations

Sample Survey Items

Q1
Multiple Choice
In the last 30 days, how often have you seen an AI safety prompt or refusal message?
  • Never
  • Once
  • 2–3 times
  • 4–6 times
  • 7+ times
Q2
Multiple Choice
Where have you seen these messages recently? Select all that apply (last 30 days).
  • General-purpose AI assistant
  • Search engine
  • Social media bot
  • Customer support chatbot
  • Developer tool/code assistant
  • Productivity app integration
  • Other
Q3
Opinion Scale
How important is clear guidance when an AI refuses a request?
Range: 1 – 10
Min: Not importantMid: NeutralMax: Extremely important
Q4
Multiple Choice
Attention check: To confirm you are paying attention, please select "I understand."
  • I understand
  • I do not understand
Q5
Chat Message
Message A (example):
Q6
Rating
How clear is Message A?
Scale: 11 (star)
Min: Not clearMax: Very clear
Q7
Opinion Scale
How helpful is Message A for guiding safe next steps?
Range: 1 – 10
Min: Not helpfulMid: Moderately helpfulMax: Extremely helpful
Q8
Multiple Choice
Which words describe the tone of Message A? Select up to three.
  • Respectful
  • Helpful
  • Clear
  • Robotic
  • Vague
  • Judgmental
  • Condescending
Q9
Long Text
If you could edit Message A to improve it, what would you change?
Max 600 chars
Q10
Chat Message
Message B (example):
Q11
Rating
How clear is Message B?
Scale: 11 (star)
Min: Not clearMax: Very clear
Q12
Opinion Scale
How helpful is Message B for guiding safe next steps?
Range: 1 – 10
Min: Not helpfulMid: Moderately helpfulMax: Extremely helpful
Q13
Multiple Choice
Which words describe the tone of Message B? Select up to three.
  • Respectful
  • Helpful
  • Clear
  • Robotic
  • Vague
  • Judgmental
  • Condescending
Q14
Long Text
If you could edit Message B to improve it, what would you change?
Max 600 chars
Q15
Multiple Choice
Which example would you prefer to receive in a real product?
  • Message A
  • Message B
  • No preference
Q16
Ranking
Rank what matters most in a refusal or safety message (1 = most important).
Drag to order (top = most important)
  1. Explains why it can’t comply
  2. Offers safe alternatives
  3. Uses plain, simple language
  4. Polite and non-judgmental tone
  5. Brief length (concise)
  6. Links to trustworthy resources
Q17
Multiple Choice
What guidance would help you act safely after a refusal? Select all that apply.
  • Step-by-step safer method
  • Examples of allowed questions
  • Links to trustworthy resources
  • Short policy summary
  • Offer to rephrase the request
  • Other
Q18
Short Text
Briefly, what were you trying to accomplish the last time you saw a refusal?
Max 100 chars
Q19
Opinion Scale
Overall, how satisfied are you with AI safety/refusal messages you’ve seen in the last 30 days?
Range: 1 – 10
Min: Very dissatisfiedMid: NeutralMax: Very satisfied
Q20
Dropdown
What is your age?
  • Under 18
  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q21
Multiple Choice
Which gender do you identify with?
  • Woman
  • Man
  • Non-binary
  • Self-describe
  • Prefer not to say
Q22
Short Text
If you chose Self-describe, you can share your gender here (optional).
Max 100 chars
Q23
Dropdown
Where do you primarily live?
  • Africa
  • Asia
  • Europe
  • North America
  • Oceania
  • South America
  • Prefer not to say
Q24
Multiple Choice
What is your highest level of education?
  • Some high school or less
  • High school or equivalent
  • Some college/Associate
  • Bachelor’s degree
  • Graduate or professional degree
  • Prefer not to say
Q25
Multiple Choice
What best describes your current employment status?
  • Full-time
  • Part-time
  • Self-employed
  • Student
  • Unemployed
  • Retired
  • Prefer not to say
Q26
Chat Message
Welcome! This short survey (about 5–7 minutes) asks about your recent experiences with AI safety/refusal messages. Please answer based on the last 30 days. You may skip any question that feels sensitive. Thank you for your time.
Q27
Long Text
Any other comments or suggestions about AI safety/refusal messages?
Max 600 chars
Q28
AI Interview
AI Interview: 2 Follow-up Questions on Your Responses
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Q29
Chat Message
Thanks for your feedback—your responses have been recorded.

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