---
generated_by: surveylegend-page-markdown
title: Blockchain Pilot Survey Template | SurveyLegend
description: Review partner participation, shared records and unresolved
  decisions before a blockchain pilot. Adapt seven practical questions in
  SurveyLegend.
canonical: https://www.surveylegend.com/survey-examples-templates/technology-digital-experience-surveys/blockchain-pilot-template/
---

# Blockchain Pilot Survey Template

A blockchain pilot needs more than interest in the technology. Use seven questions to clarify the shared-record problem, partner participation and the evidence needed before a trial.

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**SurveyLegend** 1 / 7

Blockchain Pilot Survey

Which problem in the current record-sharing process most needs attention?

Conflicting versions of a record

Slow handoffs between organizations

Unclear responsibility for updates

+5 more answer choices

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Blockchain Pilot Survey [Preview](https://www.surveylegend.com/survey-examples-templates/technology-digital-experience-surveys/blockchain-pilot-template/#try-template)

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A blockchain pilot needs more than interest in the technology. Use seven questions to clarify the shared-record problem, partner participation and the evidence needed before a trial.

This blockchain pilot survey helps participating teams describe what must be agreed before a trial begins. It starts with the business task, not a promise that blockchain will solve it. Build the original questionnaire in SurveyLegend and use the responses to prepare a focused scoping discussion.

## When to Use This Template

Use it when several organizations are considering a shared record for a specific process, such as tracking a handoff. Describe the proposed workflow in plain language before the questions. Include people who would enter, check and use records, not only project sponsors. A conventional shared database or a simpler process change should remain an option.

**Create your blockchain pilot survey in SurveyLegend**

This blockchain pilot survey helps participating teams describe what must be agreed before a trial begins. It starts with the business task, not a promise that blockchain will solve it.

## 7 Blockchain Pilot Survey Questions

Answer about the proposed shared-record pilot described above. Every question is optional. Share process-level views only; do not enter partner names, confidential contracts, credentials, wallet details or actual transaction records.

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## A little feedback. A clearer picture.

Explore this 7-question example at your own pace. Every question is optional.

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SurveyLegend demo Question 1 of 7

### Blockchain Pilot Survey

01 Which problem in the current record-sharing process most needs attention?

Choose one answer, or skip this question.

Conflicting versions of a record Slow handoffs between organizations Unclear responsibility for updates Difficulty checking a record's history Repeated manual entry No important problem has been identified Another problem Not sure

02 How clear is the reason for testing blockchain rather than a simpler alternative?

Choose one answer, or skip this question.

Very unclear Somewhat unclear Neither clear nor unclear Somewhat clear Very clear Alternatives have not been compared Not sure

03 How far has participation by the necessary partner organizations been confirmed?

Choose one answer, or skip this question.

Partners have not yet been identified Partners have been identified but not consulted Some necessary partners have expressed interest All necessary partners have expressed interest Trial responsibilities have been agreed Not sure

04 Which shared-record rule most needs agreement before a pilot?

Choose one answer, or skip this question.

Who can enter records Who can view records How incorrect entries are corrected Who checks source information Who resolves disagreements Rules are already agreed Another rule Not sure

05 What is the main practical barrier to testing the proposed process?

Choose one answer, or skip this question.

Staff time Integration with existing systems Consistent source data Partner participation Cost of the trial Unclear ownership of the pilot No main barrier identified Another barrier Not sure

06 Which result would be most useful when judging whether to continue after the pilot?

Choose one answer, or skip this question.

Less time reconciling records Fewer repeated entries Clearer handoff history More consistent partner participation Easier resolution of record disagreements A different result No success measure has been agreed Not sure

07 What assumption should the team test before agreeing to this pilot?

Share your answer, or skip this question.

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## How to Adapt the Questionnaire

Name one workflow and state what a trial would and would not include. Define “partner,” “record” and “pilot” for this audience. Keep a simpler alternative in the description and check for [leading questions ](https://www.surveylegend.com/survey-questions/leading-questions/)that imply adoption is already the right choice. Do not ask respondents to approve security or contractual terms through a preference survey.

## When to Ask

Collect responses before the scoping meeting and before a purchase or integration commitment. Allow each participating role to answer independently. Revisit the unanswered assumptions after the team gathers actual process, cost and technical evidence; repeating opinions alone will not establish feasibility.

## How to Use the Responses

Review disagreement before calculating an overall summary. A sponsor may see confirmed interest while an operator reports no agreed responsibilities; that difference needs a conversation. Count “not sure” as an information gap rather than negative readiness. Use the final [open-ended question ](https://www.surveylegend.com/customer-insight/open-ended-survey-questions/)to build an assumption log with an owner and evidence source. Do not combine the answers into an adoption score. The next action may be a smaller experiment, a simpler system or a decision not to proceed.

## What the Research Adds

Sternberg, Hofmann and Roeck’s supply-chain case study highlights “tensions between drivers for and against” blockchain adoption. Their abstract explains that one actor’s adoption decision affects others in the chain. This informs the separate questions about partner participation and shared rules. A single case does not establish a universal adoption formula or prove blockchain is suitable for this project. Read the [blockchain adoption study ](https://onlinelibrary.wiley.com/doi/abs/10.1111/jbl.12240)(published online in 2020; journal issue 2021).

## Frequently asked questions

### Does this template recommend blockchain?

No. It helps surface assumptions about one proposed pilot, including whether a simpler alternative has been considered.

### Is there a blockchain readiness score?

No. Report specific disagreements and missing decisions. Adding a score would imply a measurement model this original questionnaire does not have.

### Should partners share real records in their answers?

No. Collect process-level feedback here. Review actual records and technical materials separately through approved systems.

## Printable Blockchain Pilot Survey

Place the same plain-language pilot summary above the seven questions. Provide circles for Questions 1–6 and a lined assumption box for Question 7. Do not add approval signatures, transaction fields or a scoring total. Paper responses need separate review or manual entry; they are not automatically added to online results.

![First page of the printable Blockchain Pilot Survey Template with questions and answer spaces](https://www.surveylegend.com/survey-template-media/pdf-previews/blockchain-pilot-template-pdf-preview.avif)

[![](https://www.surveylegend.com/user-guide-media/icons/download-pdf.svg) Download the questionnaire](https://www.surveylegend.com/downloads/survey-templates/blockchain-pilot-survey-template.pdf)

Export Blockchain Pilot Survey as PDF

## AI Prompt: Blockchain Pilot Survey

Copy this blockchain pilot survey prompt into an AI assistant to prepare the questionnaire. Review the result, then build and customize it in SurveyLegend. It does not automatically create or transfer a survey.

## Blockchain Pilot Survey Prompt

AI Prompt: Blockchain Pilot Survey

[Create this survey in SurveyLegend](https://www.surveylegend.com/register/)

Copy the prompt into an AI assistant to draft the questions, then build your survey in SurveyLegend.

[Sign in](https://app.surveylegend.com/) to SurveyLegend to build your blockchain pilot survey

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