Data gathering instrument

 Task: Create one (1) instrument that could be used to gather data for your mock dissertation topic. The instrument should be designed to be exactly how it would be deployed to collect data. Since instrumentation usually goes through several steps of field testing, for purposes of this assignment you can submit a deployment-ready draft of your instrument without field testing it. Be sure the instrument collects data appropriately to measure your research question.  If your study will not use an instrument to collect data because your data is archival and already exists, you will discuss your process for data retrieval.

Some examples in below link