CITIZEN/CLIENT SATISFACTION SURVEY FORM
Please help us improve our services!  We will appreciate if you can spare us a moment to answer this survey form.
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Email *
Date of Visit *
MM
/
DD
/
YYYY
Time of Visit *
Time
:
Office/Person Visited *
Please check appropriate item: *
What is the purpose of your visit/ transaction? *
Required
Please rate your satisfaction level regarding the services rendered by clicking the circle of your choice using the scale indicated:
Responsiveness *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. In responding to your request in a timely manner.
2. In facilitating your queries or needs with courtesy and politeness.
3. Demonstrating willingness to facilitate your request or needs.
Reliability *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. In performing the services right the first time.
2. Providing you information with accuracy.
Access and Facilities *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. On materials or other facilities associated with the services as to quality and functionality to ensure comfortable transactions.
2. In providing you services in accessible manner.
3. The display of signages to assist or guide you find your way around.
Communication *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. The display of Citizen Charter or procedures showing all services that you can avail.
2. Ability to clarify your issues/queries effectively.
3. In listening and interacting with you to obtain actionable information.
Integrity *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. Ensuring safety and security during your transactions.
2. Delivering you services in an honest and ethical manner.
3. The accuracy of information sought for.
Assurance *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. Knowledge to answer your questions/concerns.
2. Providing you resources you need in accordance with the established processes.
3. The provision of needed assistance or resources specific to your needs.
Outcome *
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. Providing you the overall high quality services
2. Putting you at the center of everything they do all to meet your expectations.
Cost (If applicable to transactions made)
Very Satisfied
Satisfied
Neither Satisfied nor Dissatisfied
Dissatisfied
Very Dissatisfied
1. On assessment or payment instruction upon receipt of the requested document.
2. Providing you negotiable /flexible payment period like use of promissory note.
3. Delivering you quality education/ training and/or services.
4. Assessing services with acceptable/affordable fee.
Clear selection
5. What is your overall impression about the cost and quality of services in CSU?
Overall Satisfaction: *
Comments/Suggestions for improvement:
Name (Last Name, Given Name, Middle Initial): *
Agency/Office/Address: *
Contact Number: *
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