Customer Effort Score Survey Template

Customer effort score survey template with 4 questions covering ease of resolution, effort level, and issue outcome.

This is a ready-made survey template you can use two ways. Print it on paper and hand it out, then scan the completed forms and PaperSurvey reads the answers for you automatically, no manual typing. Or share the very same template as an online web survey. The preview below shows the printable paper version.

Use this template

Copy this template into your account, then customize it to suit your needs.

This printable customer effort score survey helps support and service teams measure how hard customers have to work to get an issue resolved, using 4 questions on a single page. It prints on one sheet and takes about two minutes to complete, so you can hand it to every customer instead of relying on email surveys that most people ignore.

What this survey measures

The core of the customer effort score is a short agreement grid, led by the standard statement "The company made it easy for me to handle my issue," alongside prompts about repeating information and clarity of the steps. A pick-one question captures the effort level customers felt they had to put in, and a simple resolution question records whether the issue was fully resolved, unresolved, or only partly handled. An open comment box invites specific suggestions for removing friction the fixed questions may miss.

How to use it on paper

Hand the survey to customers at the end of a service interaction, at a help desk, or include it with a shipped order or repair. Customers fill the checkboxes with a blue or black pen. Collect the completed forms and scan them in batches: PaperSurvey reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results appear in your dashboard without any manual data entry.

Customize this template

Add your company logo, reword the statements to match your service channel, or add and remove questions to fit your process. The paper layout reflows automatically as you edit, and every copy you print stays scannable.

Preview the PDF above, or use this template to start measuring customer effort today.

Paper and web from one template

Every PaperSurvey template is a hybrid survey: run it on paper and scan the forms, share it online as a web survey, or do both at once and collect all the responses in one place. to see how it looks online, or open it in a new tab. It is a live preview only, so nothing you enter is saved.

Questions in this template

  1. Please rate how much you agree with the following statements.
  2. How much effort did you personally have to put in to get your issue resolved?
  3. Which channel did you use to contact us?
  4. How many times did you have to reach out before your issue was handled?
  5. Was your issue resolved?
  6. How long did it take to get your issue resolved?
  7. Thinking about the resolution, how much do you agree with the following?
  8. Overall, how satisfied are you with how your issue was handled?
  9. What could we do to make things easier for you?
  10. If you would like us to follow up, please share your email address.

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