Evaluator:

Division / Program:________________

Job Class:__________________  

Product:

Product Name:___________________

No. of Times Used:___________

Please circle the most appropriate answer for each question.  Not applicable (N/A) may be used if the question does not apply to this particular product.     --------------------------------------------------------         

   Agree          Disagree

During Use:

1.       The safety feature can be activated using a one-handed technique.

1

2

3

4

5

N/A

2.       The safety feature does not obstruct vision of the tip of the sharp.

1

2

3

4

5

N/A

3.       Use of this product requires you to use the safety feature.

1

2

3

4

5

N/A

4.       This product does not require more time to use than a non-safety device.

1

2

3

4

5

N/A

5.       The safety feature works well with a wide variety of hand sizes.

1

2

3

4

5

N/A

6.       The device is easy to handle while wearing gloves.

1

2

3

4

5

N/A

7.       This devise does not interfere with uses that do not require a needle.

1

2

3

4

5

N/A

8.       This device offers a good view of any aspirated fluid.

1

2

3

4

5

N/A

9.       This device will work with all required syringe and needle sizes.

1

2

3

4

5

N/A

10.   This device provides a better alternative to traditional recapping. 

1

2

3

4

5

N/A

After Use:

11.   There is a clear change (audible or visible) when the safety feature is activated.

1

2

3

4

5

N/A

12.   The safety feature operates reliably.

1

2

3

4

5

N/A

13.   The exposed sharp is permanently blunted or covered after use and prior to disposal.

1

2

3

4

5

N/A

14.   This device is no more difficult to process after use than non-safety devices. 

1

2

3

4

5

N/A

Training:

15.   The user does not need extensive training for correct operation.

1

2

3

4

5

N/A

16.   The design of the device suggests proper use.

1

2

3

4

5

N/A

17.   It is not easy to skip a crucial step in proper use of the device.

1

2

3

4

5

N/A