35 Questionnaire Template

All You Need to Know About Questionnaire Template — Questionnaire is a data collection technique that can be used by researchers to study, obtain data and analyze trends, attitudes, attitudes, behavior, character and characteristics of questionnaire participants, in this case the participant is someone within a scope within a system. or organization.

By utilizing a questionnaire, researchers will try to assess and measure what has been obtained. The form of the questionnaire or the questionnaire itself is in the form of a list of questions which the respondent will answer so that the data needed by the researcher will be collected.

In order to make the questionnaire template more understandable, researchers can see the following functions of the questionnaire which are the questionnaire is used to collect data, it is used for analysis and making follow-up evaluations. As a guarantee of verification of information obtained from other means or methods. And to obtain opinions, opinions and views of respondents.


Instructions for Making Questions


  • Use simple words that all respondents can understand. Avoid fancy terms that the respondent doesn’t understand or doesn’t understand.

For example : “What is your marital status?” it’s better “Are you married?”

  • Try to keep the questions clear and specific.

For example : “How many people live here?”

  • Avoid questions that have more than one meaning.

For example : “Do you want to find a job in the city?” Better “Are you looking for a job? If the answer is “Yes”, then it is asked “Where do you want to work?”

  • Avoid questions that contain suggestions.

For example : “In your spare time, do you listen to the radio or do anything else?” Better “What do you do in your spare time?”

  • Questions should apply to all respondents.

For example : “What is your job now?” It turned out that he was unemployed. It should be asked first “Do you work?” If the answer is “Yes” then it is asked “Your job?”


Types of Questions


  • Closed questions. Possible answers are predetermined and respondents are not given the opportunity to provide other answers on the questionnaire template.

For example : “Have you ever heard of family planning?”

  • Answer options : 1. Yes 2. Never
  • Open questions. Possible answers are not determined in advance and respondents are free to provide answers.

For example: “In your opinion, what is the most important problem for women in the city?”

  • Combination of closed and open. The answer has been determined but then followed by open questions.

For example: “Have you ever heard about ways to space pregnancy or limit pregnancy?”

Answer options: 1. Yes 2. Never (If so) What ways have you heard?

  • Semi-open question. In semi-open questions, the answers have been arranged but there are still possibilities for additional answers.

For example: “What kind of contraception is used?”

Answer options: IUD (1) Pill (2) Condom (3) Injection (4) Sterilization (5) Others… (specify)


Composition of Questions


Questions are grouped according to research objectives, starting with an identity containing: (1) name of respondent (2) place of residence (3) name of interviewer (4) date of interview. Then followed by questions about demographic characteristics: gender, age, education, status, etc.


In the pattern of preparing the research questionnaire template, it is submitted to the researcher how the grouping of questions is carried out, the extent to which the researcher wants to explore a specific information from the respondent. What needs to be considered is the order in which it is fairly straightforward and also where sensitive questions are placed.


Sensitive questions are not placed on the front as they can immediately affect the mood of the interview. Usually these kinds of questions are placed on the back, but not at the end so that the interview doesn’t end feeling badly.


Some Examples of Questionnaire Templates


Example of an Open Questionnaire Template


As for an example of an open questionnaire template with the research title;

Student Satisfaction Levels with Facilities in the Library

As questions in an open questionnaire, for example;

Do you often use the library facilities in the school?


Example of a Closed Questionnaire Template


Questionnaire with two alternative answers.

Are the books in the library sufficient to meet your learning needs?

Yes (    )

No (     )

Questionnaire with three or more answers.

What do you think if the library is equipped with an Internet connection?

Strongly agree (          )

Strongly agree (          )

Agree Disagree less ( )

Disagree (       )


Examples of Mixed Questionnaire Template


For example;

Do you agree that the Internet connection can be accessed free of charge by all students?

(           ) Agree, the reason ..

(           ) Disagree, the reason…


Examples of Research Questionnaire Templates


Instructions for filling in:

Please answer the following questions by filling in the answers or putting a check mark (√) in the boxes provided below!


Respondent Identity

  1. Number:
  2. Name (Initials):
  3. Age:
  4. Gender: (1) Male (2) Female [            ]
  5. Last education:

1) No School / Did not graduate from elementary [   ]

2) Elementary School [           ]

3) Junior High School [           ]

4 ) Senior High School [         ]

5) Higher Education [              ]


  1. Occupation:

1) PNS / Retired PNS [           ]

2) POLRI / TNI / Retired [       ]

3) Private / Entrepreneur [      ]

4) Housewife [             ]

5) Farmers [    ]

6 ) Others [      ]




Examples of Customer Satisfaction Questionnaire Templates


Name of Respondent:

Age of Respondent:


Last Education:




  1. In your opinion, what is the flow in the KIA section of the Beauty Health Center for treatment / control / immunization?
  • Not easy
  • Less easy
  • Easy
  • Very easy


  1. In your opinion, does it match the service requirements (baby card, pregnant women) with the type of service you receive at the KIA section of the Beauty Health Center? Is it available according to your wishes?
  • Not suitable
  • Less appropriate
  • Appropriate
  • Very appropriate


  1. How do you think the clarity of officers who provide services at the health center MCH Beauty? Do you already understand what special services in the MCH room are?
  • Unclear
  • Less Clear
  • Clear
  • Very Clear


  1. In your opinion, how disciplined are the officers in providing services at the KIA section of the Beauty Health Center?
  • Not disciplined
  • Lack of discipline
  • Discipline
  • Very disciplined


  1. In your opinion, what is the responsibility of the officers in the KIA section of the Beauty Community Health Center to provide services? Do midwives serve you according to their profession?
  • Irresponsible
  • Lack of Responsibility
  • Very Responsible


  1. In your opinion, what is the ability of the officers in the KIA section of the Beauty Health Center to provide services to you?
  • Not able
  • Not able to afford
  • Can afford
  • Very capable


  1. In your opinion, how fast is the service provided at the KIA section of the Beauty Health Center?
  • Not fast
  • Not really
  • Fast
  • Very fast


  1. In your opinion, how is the justice provided by the service at the KIA section of the Beauty Health Center? Are you called according to your serial number?
  • Unfair
  • Mildly Unfair
  • Fair
  • Very fair


  1. In your opinion, how friendly is the officer in providing services at the KIA section of the Beauty Health Center?
  • Not polite and friendly
  • Less polite and friendly
  • Polite and friendly
  • Very polite and friendly


  1. In your opinion, how much does it cost to get services at the KIA section of the Beauty Health Center, is it reasonable?
  • Unnatural
  • Less reasonable
  • Reasonable
  • Very reasonable



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The basic aim of making the questionnaire template is to obtain information relevant to the purpose of research and information with the highest possible reliability and validity. Given the limited problems that can be asked in the questionnaire, it is necessary to keep in mind that the questions are directly related to the hypothesis and the research objectives.