This survey will provide the Department with an opportunity to document your comments, suggestions, and concerns regarding our current services, our job performance, and future issues. Please take a moment to complete this survey
Name: (This information is optional.)
Address:
City:
Telephone:
E-mail Address:
Services provided: PLEASE RATE:
Response time		Excellent Good Fair Poor N/A
Courtesy of staff		Excellent Good Fair Poor N/A
Knowledge of staff assisting you		Excellent Good Fair Poor N/A
Helpfulness of information - Written		Excellent Good Fair Poor N/A
Helpfulness of information - Verbal		Excellent Good Fair Poor N/A
Staff availability		Excellent Good Fair Poor N/A
Information about the process		Excellent Good Fair Poor N/A
Appropriate follow-up		Excellent Good Fair Poor N/A
Overall satisfaction with the service		Excellent Good Fair Poor N/A
If you answered FAIR or POOR to any of the previous questions, please indicate what was unsatisfactory about the service:
In order to improve our service, we would appreciate your comments and suggestions:
If you would like to recognize an employee who provided excellent service, please indicate their name and how they assisted you:
Please identify any priorities, issues or opportunities that you believe may be important for our Department in the future.