This questionnaire is a combination of  7 point Likert scales, open form questionnaires to collect qualitative and quantitative user feedback, and checklist for trust between people and automation from Jian et al. (2000).

[ Jian, J. Y., Bisantz, A. M., & Drury, C. G. (2000). Foundations for an empirically determined scale of trust in automated systems. International journal of cognitive ergonomics, 4(1), 53-71 ; https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=ed6a076ab7d43c27085d412108b98b93edbb1b00].

It was developed to evaluate the trust in a virtual agent + a speech recognition system. It is coupled with  Jian et al. (2000)' scale. This scale of 12 items measures the trust and distrust in automation.

In the first part of the questionnaire, you can replace the term [the virtual agent] by your own system.



Reference: Weitz, K., Schiller, D., Schlagowski, R., Huber, T., & André, E. (2021). “Let me explain!”: exploring the potential of virtual agents in explainable AI interaction design. Journal on Multimodal User Interfaces, 15(2), 87-98.
https://link.springer.com/content/pdf/10.1007/s12193-020-00332-0.pdf