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Surveys
2010
October
T
Training Services
Training Services
0%
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Date
Time of visit
Walk-In
Appointment
Home Visit
Other
Was it difficult to contact us or apply for service?
Yes
No
Were you referred to the right program for assistance?
Yes
No
Did you receive the service you requested?
Yes
No
How long did you have to wait for service?
No waiting time
Under 15 minutes
15-30 minutes
over 30 minutes
How would you rate our service?
1
2
3
4
5
6
7
8
9
10
Respectfulness of staff
Sensitivity of staff
Staff listened to your concerns
Staff provided needed information
Staff responded to your needs
Overall quality of service
Why did you provide this rating for the
Overall Quality of Service
question?
How can we improve? Other details you would like to share?
If you would like to share additional information or receive a follow-up call, please provide your contact information.
Name
Phone
Best Time to Call
Internal Information
Date & Time
Employee Name
Program Department
Referred From
Program Department
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