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    Client Citizens Satisfaction Survey Form

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    Agojo Integrated School
    This document is a client satisfaction survey form from the Department of Education of the Republic of the Philippines. It collects information about the client's experience, including the office visited and services received. It then asks the client to rate their satisfaction with 8 criteria of public service on a scale from very dissatisfied to very satisfied. These criteria include responsiveness, reliability, access and facilities, communication, costs, integrity, assurance, and outcome. Finally, it provides space for additional comments, compliments or suggestions and notifies that any personal information provided will only be used for administering the survey.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Client Citizens Satisfaction Survey Form

    Uploaded by

    Agojo Integrated School
    469 views1 page
    This document is a client satisfaction survey form from the Department of Education of the Republic of the Philippines. It collects information about the client's experience, including the office visited and services received. It then asks the client to rate their satisfaction with 8 criteria of public service on a scale from very dissatisfied to very satisfied. These criteria include responsiveness, reliability, access and facilities, communication, costs, integrity, assurance, and outcome. Finally, it provides space for additional comments, compliments or suggestions and notifies that any personal information provided will only be used for administering the survey.

    Original Description:

    Survey Form for Visitors

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    This document is a client satisfaction survey form from the Department of Education of the Republic of the Philippines. It collects information about the client's experience, including the office visited and services received. It then asks the client to rate their satisfaction with 8 criteria of public service on a scale from very dissatisfied to very satisfied. These criteria include responsiveness, reliability, access and facilities, communication, costs, integrity, assurance, and outcome. Finally, it provides space for additional comments, compliments or suggestions and notifies that any personal information provided will only be used for administering the survey.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    469 views1 page

    Client Citizens Satisfaction Survey Form

    Uploaded by

    Agojo Integrated School
    This document is a client satisfaction survey form from the Department of Education of the Republic of the Philippines. It collects information about the client's experience, including the office visited and services received. It then asks the client to rate their satisfaction with 8 criteria of public service on a scale from very dissatisfied to very satisfied. These criteria include responsiveness, reliability, access and facilities, communication, costs, integrity, assurance, and outcome. Finally, it provides space for additional comments, compliments or suggestions and notifies that any personal information provided will only be used for administering the survey.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines

    Department of Education
    Client/Citizens Satisfaction Survey Form Control No.: ________________________

    Your experience matters to us!


    Ang iyong karanasan ay mahalaga sa amin!

    I. Client Information (Impormasyon ng Kliyente)


    Name (Optional) Date Visited
    Pangalan (Opsyonal Petsa ng Pagbisita
    Office visited
    Opisinang binisita Contact details
    Service/s received
    Serbisyong natanggap

    II. Client Satisfaction Rating


    Kindly rate the quality of service provided by checking the appropriate box. Leave as blank if the criterion is not applicable for the
    service. (Lagyan ng tsek ang kahong nagsasaad ng iyong karanasan ukol sa serbisyong natanggap. Iwanang blanko ang pamantayan
    kung ito ay hindi angkop sa serbisyong natanggap.)

    CRITERIA Very Dissatisfied


    Lubhang hindi nasiyahan
    Dissatisfied
    Hindi nasiyahan
    Neutral Satisfied Very Satisfied
    Lubhang nasiyahan
    Nasiyahan
    1. RESPONSIVENESS (PAGTUGON)
    Willingness to help, assist, and provide prompt service (Handang
    tumugon at magbigay nang mabilis na serbisyo sa kliyente.
    2. REALIABILITY (MAAASAHAN)
    Provision of what was needed and what was promised, in accordance
    with the policy and standards, with zero to a minimal error rate
    (Mahusay na pagbibigay ng serbisyo ayon sa itinakdang pamantayan)
    3. ACCESS & FACILITIES (LOKASYON AT PASILIDAD)
    Convenience of location, ample aminities for a comfortable transaction,
    and the use of clear signages and modes of technology (Mabilis
    mapuntahan ang lugar at maggamit ang pasilidad sa pamamagitan ng
    malinaw na karatula)
    4. COMMUNICATION (PAKIKIPAG-USAP)
    Act of keeping citizens and business informed in a language they can
    easily understand, as well as listening to their feedback (Pakikipag-
    ugnayan sa kliyente sa paraang malinaw at nauunawaan kasama ang
    mga opinion at puna)
    5. COSTS (GASTOS)
    Satisfaction with the timeliness of the billing, billing process/es,
    preferred methods of payment period, value of money, acceptable range
    of cost and qualitative information on the cost of each service (Kontento
    sa serbisyong natanggap at sa halagang nagging katumbas o
    binayaran)
    6. INTEGRITY (KATAPATAN)
    Capability of frontline staff/s to perform their duties, product, and
    service knowledge, understanding client needs, helpfulness, in good
    work relationships (Kasiguruhan na gampanan ang tungkulin, na may
    kaalaman sa serbisyo, pag-unawa sa mga pangangailangan ng kliyente,
    matulungin, at maayos na ugnayan sa trabaho)
    7. ASSURANCE (PAGTITIWALA)
    Assurance that there is honesty, justice, fairness, and trust in eac
    service while dealing with the clients and businesses (Pagtiyak sa
    serbisyong may katapatan, hustisya, patas at tiwala habang nakikipag
    ugnayan sa kliyente)
    8. OUTCOME
    Rate in terms of achieving outcomes or realizing the intended benefits of
    the service (Markahang ang pangkahalatang serbisyo na natanggap)
    III. Suggestions/Compliments/Comments (Suhestiyon/Papuri/Komento)
    _________________________________________________________________________________________________
    _________________________________________________________________________________________________
    __ Thank you for your valuable input to help us continuously improve our
    services!
    Private Notice: Private Notice:
    Maraming
    The personal information included in this document should only be used for the salamat sa iyong tulong para sa ikauunlad ng amingAng
    serbisyo!
    personal na impormasyon sa dokumentong ito ay maaari lamang gamitin para sa
    Purposes of administering the survey. Any personal information included herein may layunin ng survey na ito. Hindi ito maaring gamitin sa iba pang layunin maliban sa
    not be used for other purposes aside from those stated above. nabanggit.

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