NISUFoSRIPDU09 NISUFoSRIPDU09

Revised November 29, 2023 Revised November 29, 2023

Republic of the Philippines Republic of the Philippines

CLIENT FEEDBACK FORM CLIENT FEEDBACK FORM

Client type: ☐ Citizen ☐ Business ☐ Government (Employee of another agency) Client type: ☐ Citizen ☐ Business ☐ Government (Employee of another agency)
☐ Student ☐ Alumni ☐ NISU Faculty ☐ NISU Staff ☐ Student ☐ Alumni ☐ NISU Faculty ☐ NISU Staff

Date: ___________ Sex: ☐ Male ☐ Female Age: _______ Date: ___________ Sex: ☐ Male ☐ Female Age: _______

Region of residence: _____________ Service Availed: ____________________________ Region of residence: _____________ Service Availed: ____________________________

INSTRUCTIONS: Check mark (✔ ) your answer to the Citizen’s Charter (CC) questions. The INSTRUCTIONS: Check mark (✔ ) your answer to the Citizen’s Charter (CC) questions. The
Citizen’s Charter is an official document that reflects the services of a government agency/office Citizen’s Charter is an official document that reflects the services of a government agency/office
including its requirements, fees, and processing times among others. including its requirements, fees, and processing times among others.

CC1 Which of the following best describes your awareness of a CC? CC1 Which of the following best describes your awareness of a CC?
☐ 1. I know what a CC is and I saw this office’s CC. ☐ 1. I know what a CC is and I saw this office’s CC.
☐ 2. I know what a CC is but I did NOT see this office’s CC. ☐ 2. I know what a CC is but I did NOT see this office’s CC.
☐ 3. I learned of the CC only when I saw this office’s CC. ☐ 3. I learned of the CC only when I saw this office’s CC.
☐ 4. I do not know what a CC is and I did not see one in this office. (Answer ☐ 4. I do not know what a CC is and I did not see one in this office. (Answer
‘N/A’ on CC2 and CC3) ‘N/A’ on CC2 and CC3)

CC2 If aware of CC (answered 1-3 in CC1), would you say that the CC of this CC2 If aware of CC (answered 1-3 in CC1), would you say that the CC of this
office was …? office was …?
☐ 1. Easy to see ☐ 4. Not visible at all ☐ 1. Easy to see ☐ 4. Not visible at all
☐ 2. Somewhat easy to see ☐ 5. N/A ☒ 2. Somewhat easy to see ☐ 5. N/A
☐ 3. Difficult to see ☐ 3. Difficult to see

CC3 If aware of CC (answered codes 1-3 in CC1), how much did the CC help you CC3 If aware of CC (answered codes 1-3 in CC1), how much did the CC help you
in your transaction? in your transaction?
☐ 1. Helped very much ☐ 3. Did not help ☐ 1. Helped very much ☐ 3. Did not help
☐ 2. Somewhat helped ☐ 4. N/A ☐ 2. Somewhat helped ☐ 4. N/A

INSTRUCTIONS: INSTRUCTIONS:
For SQD 0-8, please put a check mark (✔ ) on the column that best corresponds to your For SQD 0-8, please put a check mark (✔ ) on the column that best corresponds to your
answer. answer.

Strongly Disagree Neither Agree Strongly Strongly Disagree Neither Agree Strongly
Disagree Agree nor Agree Disagree Agree nor Agree
Disagree Disagree
(1) (2) (3) (4) (5) (1) (2) (3) (4) (5)
I am satisfied with the service that I I am satisfied with the service that I
availed. availed.
Responsiveness. I spent a Responsiveness. I spent a
reasonable amount of time for my reasonable amount of time for my
transaction. transaction.
Reliability. The office followed the Reliability. The office followed the
transaction’s requirements and steps transaction’s requirements and steps
based on the information provided. based on the information provided.
Access and Facilities. The steps Access and Facilities. The steps
(including payment) I needed to do (including payment) I needed to do
for my transaction were easy and for my transaction were easy and
simple. simple.
Communication. I easily found Communication. I easily found
information about my transaction information about my transaction
from the office or its website. from the office or its website.
Costs. I paid a reasonable amount Costs. I paid a reasonable amount
of fees for my transaction. of fees for my transaction.
Integrity. I feel the office was fair to Integrity. I feel the office was fair to
everyone, or “walang palakasan”, everyone, or “walang palakasan”,
during my transaction. during my transaction.
Assurance. I was treated Assurance. I was treated
courteously by the staff, and (if courteously by the staff, and (if
asked for help) the staff was helpful. asked for help) the staff was helpful.
Outcome. I got what I needed from Outcome. I got what I needed from
the government office, or (if denied) the government office, or (if denied)
denial of request was sufficiently denial of request was sufficiently
explained to me. explained to me.

Suggestions on how we can further improve our services (optional): Suggestions on how we can further improve our services (optional):

____________________________________________________________________________ ____________________________________________________________________________

____________________________________________________________________________ ____________________________________________________________________________

Email address (optional): __________________________________ Email address (optional): __________________________________

THANK YOU! THANK YOU!

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