.:Hablamos Juntos: Signage Symbols Survey

Recognition Testing - Round 4 of Symbols Evaluation

Thank you for your interest in answering a few questions and participating in this survey to help us learn more about proposed symbols for health care. The goal of this round is to learn the recognition value of these symbols.

This is a two part survey. After completing the first part, you will be given an opportunity to move on to an optional second part or to stop. The first part of this survey is the most critical.

The survey consists of a matching task. In the first part 20 symbols are presented along with a list of 11 possible referents and their definitions. You are to match a symbol with a referent.

Thank you again for your time.

We will first ask you to answer some questions about yourself, and then will move on to the symbol section of the survey. Your responses to all questions are anonymous and will be kept confidential. If you do not understand a question, please leave it blank.
I agree to participate in this survey. I understand that I may withdraw from this survey or opt not to answer any questions at any time.
	Yes		No
Do you work in a health care facility?
	Yes		No
The language I use most to speak and write is:

Your present age group is:		Under 18 25-64 Years		18-24 Years 65 Years & Above
Your Sex is: Female Male
City:		State:			Zip Code:
Do you have a visual impairment?
	Yes		No

Round 4 of Symbols Evaluation

This information is solely for the purpose of development of Symbols at the end of our program, and the information will not be disclosed to any third party outside of HJ and our partners.