911 N. 65th Avenue
Ridgefield, WA
360-887-4609
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Surplus Real Property – Hayes Road Property
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Customer Satisfaction Survey
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Customer Satisfaction Survey
Feedback questionnaire.
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Nature of your Interaction with CCFR?
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Emergency Response
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If Other, please describe:
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Location of interaction:
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Date of Interaction:
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Date Format: MM slash DD slash YYYY
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How did you find us?
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Organized Event
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If Other, please describe how you found us:
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Were you generally pleased with your interaction?
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Yes
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Please Rate the Following Areas of our Service using this scale:
5 - Outstanding Performance 4 - Exceeded Expectations 3 - Met Expectations/Average Performance 2 - Somewhat Dissatisfied 1 - Very Dissatisfied
General Customer Service Overall?
*
5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Timeliness/Speed of Response?
*
5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Appropriate Respect for Dignity, Privacy, and Property?
*
5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Quality of Patient Care?
*
5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Expertise/Knowledge of Staff?
*
5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Professionalism?
*
5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Other Area you'd like to Rate?
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Yes
No
Describe Other Area you'd like to Rate:
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Rate Other Area?
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5 - Outstanding Performance
4 - Exceeded Expectations
3 - Met Expectations/Average Performance
2 - Somewhat Dissatisfied
1 - Very Dissatisifed
0 - Not Applicable
Is there an Individual Member you would like to Recognize or voice a Concern about?
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Name of Staff Member:
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Comments about the Staff Member:
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Additional Feedback/Comments:
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