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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.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

24 questions · ~11 min
Q01
Message

Welcome to this accessibility experience survey. We are interested in your honest feedback about a recent digital product session where you used assistive technology. There are no right or wrong answers — we want your genuine experience. Your responses are confidential and will be reported only in aggregate. Participation is voluntary and you may stop at any time. No personally identifiable data is collected. Estimated time: 7–10 minutes. Please answer based on your most recent session within the past 14 days.

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).

  1. Visual clarity (contrast, size)
  2. Keyboard/navigation reliability
  3. Labels and alternative text
  4. Error messages and guidance
  5. Announcements of dynamic changes
  6. 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 Template

This 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 Surveys

This 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 Template

This 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

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