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Complaint Survey Form

Report Number  Date of Complaint
 
Nature of Complaint
 
              Call Taker
       Primary Officer
     Assisting Officer
 
Please rate each category by darkening the number that corresponds to your choice: (1- Poor, 2-Below Average, 3-Average, 4-Above average, and 5-Excellent). For questions 1 through 7, the primary officer would be the main officer on the scene who dealt directly with you and completed the paperwork, while the assisting officer, if applicable, would have been there to assist the primary officer. The call taker or dispatcher answered your call and took all the necessary information by phone.
 

1. Response Time/ Promptness
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 

2. Professionalism
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 

3. Sincerity
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 

4. Courteousness
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 

5. Communications Skills
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 

6. Follow-up
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 

7. Appearance
1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent
Primary Officer

Assisting Officer

Dispatcher/ Call Taker

 


8. Did the officer give you an item/ complaint number for your complaint?

 

9. Do you feel that an adequate amount of time was spent handling your complaint?

If no, please explain

 

10. Were you satisfied with the outcome of this matter?

If no, please explain

 

11. Do you have any suggestions as to how we can improve our services?

 

12. Would you like to be contacted by a supervisor to give additional comments or for a followup?

I yes, please provide us with your name and your email, and/or telephone number you would like to be contacted at.

        Name
Telephone   Email
 
13. Additional Comments

 

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