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Client Survey Form A4

This 3 sentence summary provides the key details about the document: This document is a citizen/client satisfaction survey form from Bulacao Elementary School in Region VII - Central Visayas, Philippines. The survey collects information about the client and rates their satisfaction with various criteria of the services received on a scale of 1 to 5. It also includes space for additional suggestions, complaints or concerns and notifies clients that any personal information collected will only be used for administering the survey.

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Diane Marie Duterte
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185 views1 page

Client Survey Form A4

This 3 sentence summary provides the key details about the document: This document is a citizen/client satisfaction survey form from Bulacao Elementary School in Region VII - Central Visayas, Philippines. The survey collects information about the client and rates their satisfaction with various criteria of the services received on a scale of 1 to 5. It also includes space for additional suggestions, complaints or concerns and notifies clients that any personal information collected will only be used for administering the survey.

Uploaded by

Diane Marie Duterte
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
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Republic of the Philippines

Department of Education
REGION VII - CENTRAL VISAYAS
BULACAO ELEMENTARY SCHOOL

Citizens/Client Satisfaction Survey Form


Your experience matters to us!
Mahinungdanon kanamo ang imong kasinatian!

I. Client Information (Impormasyon sa Kliyente)

Name (Optional) Date Visited


Pangalan (Opsyonal) Petsa sa Pagbisita
Office visited
Opisinang gibisita Contact details
Service/s received
Serbisyong nadawat
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.
(Butangi og tsek ang kahon sa imong nasinati sa serbisyong nadawat)
Satisfied Neutral Dissatisfied Very
CRITERIA
(Nakontento) (Sakto (Wala Dissatisfied
Very Satisfied lang) Nakontento) (Grabe Ka Wala
Kriterya (Nakontento Pag-ayo) Nakontento)

5 (Highest) 4 3 2 1 (Lowest)
1. RESPONSIVENESS (PAGTAGAD/PAG-ALAGAD/PAGTUBAG
Willingness to help, assist, and provide prompt service
(Naalagaran ug nahatagan dayon sa gikinahanglan nga serbisyo)
2. RELIABILITY (KASALIGAN)
Provision of what was needed and what was promised, in accordance with the
policy and standards, with zero to a minimal error rate (Nahatagan sa kalidad
ug standard nga serbisyo)
3. ACCESS & FACILITIES (LOKASYON UG PASILIDAD)
Convenience of location, ample amenities for a comfortable transaction, and
the use of clear signages and modes of technology
(Natoltolan ang lugar/pasilidad pinaagi sa mga karatola)
4. COMMUNICATION (PAG-ABI-ABI)
Act of keeping citizens and businesses informed in a language they can easily
understand, as well as listening to their feedback
(Naabi-abi, naalagaran ug nasabtan ang katoyoan/opinyon ug ang mga
komentaryo o rekomendasyon.)
5. COSTS (GASTOS)
Satisfaction with the timeliness of the billing, billing process/es, preferred
methods of payment period, value for money, acceptable range of costs, and
qualitative information on the cost of each service
(Nahatagan sa kalidad nga serbisyo. Dili mamahayan ang nagasto)
6. INTEGRITY (INTEGRIDAD)
Capability of frontline staff/s to perform their duties, product and service
knowledge, understanding client needs, helpfulness, and good work
relationships
(Napakita ang kaarang ug kaalamag sa serbisyo, pagtagad,pagtabang ug
pag-abi -abi sa gikinahanglan sa kliyente)

7. ASSURANCE (KASIGUROHAN)
Assurance that there is honesty, justice, fairness, and trust in each service
while dealing with the clients and businesses
(Siguradong tinud-anay, tarong, patas ug kasaligan ang serbisyong napaabot
o nahatag)
8. OUTCOME (RESULTA)
Rate in terms of achieving outcomes or realizing the intended benefits of the
service
(Unsa ang ikasulti nimo sa kinatibuk-ang nadawat nga serbisyo?)

III. Suggestions/Complaints/Concerns (Suhestiyon/Reklamo/Komento)


_________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Thank you for your valuable input to help us continuously improve our services!
Daghan kaayong salamat sa bililhon nimong sugyot ug input dako kayo kining tabang sa pagpadayon sa paglambo sa among serbisyo.

Privacy Notice: Privacy Notice:


The personal information included in this document should only be used for the Ang mga personal nga impormasyon nga anaa niini nga dokumento gamiton lang sa
purposes of administering the survey. Any personal information included herein may pagpatigayon niini nga survey. Dili kini pwedeng gamiton sa uban pang katoyoan,
not be used for other purposes aside from those stated above. gawas sa mga katoyoan nga anaa sa ibabaw.

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