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Questionnaire template

Website Problem Report

Lets website visitors report a technical or content problem with page, device, browser and impact details for the web team.

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Other · Complaint forms. All Other templates

Questions in this template

The Problem

  1. Sorry that something went wrong on our website. The details you give here help us find and fix the problem quickly.

  2. What kind of problem did you run into?

    Choose one:

    • A page did not load
    • A link did not work
    • An error message appeared
    • The page looked wrong or was hard to read
    • A form or checkout did not work
    • Problem signing in or with my account
    • Pages were very slow
    • Information was wrong or out of date
    • Other

  3. What kind of problem was it?

    Condition: Shown when Other is selected

    Open answer

  4. On which page did it happen? Paste the web address if you can.

    Open answer

  5. What were you trying to do, and what happened instead?

    Open answer

  6. When did you first notice the problem?

    Choose one:

    • Today
    • In the past week
    • In the past month
    • More than a month ago

  7. Does the problem happen again when you retry?

    Choose one:

    • Every time
    • Sometimes
    • It only happened once
    • I did not try again

Your Device

  1. What device were you using?

    Choose one:

    • Desktop or laptop
    • Smartphone
    • Tablet
    • Other

  2. Which web browser were you using?

    Choose one from a list:

    • Chrome
    • Safari
    • Firefox
    • Edge
    • Other
    • Don't know

  3. Which browser was it?

    Condition: Shown when Other is selected

    Open answer

  4. Which operating system does the device use?

    Choose one from a list:

    • Windows
    • macOS
    • Android
    • iOS or iPadOS
    • Linux
    • Other
    • Don't know

Impact

  1. How much did the problem get in your way?

    Choose one:

    • I could not finish what I was doing
    • I finished, but with difficulty
    • It was a minor inconvenience

Follow-up

  1. Would you like us to contact you about this problem?

    Choose one:

    • Yes
    • No

  2. Your name

    Condition: Shown when a reply is wanted

    Open answer

  3. Your email address

    Condition: Shown when a reply is wanted

    Open answer