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 12345NA
Assisting Officer 12345NA
Dispatcher/ Call Taker 12345NA  
2. Professionalism 1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent Primary Officer 12345NA
3. Sincerity 1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent Primary Officer 12345NA
4. Courteousness 1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent Primary Officer 12345NA
5. Communications Skills 1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent Primary Officer 12345NA
6. Follow-up 1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent Primary Officer 12345NA
7. Appearance 1=Poor   2=Below Average   3=Average   4=Above Average   5=Excellent Primary Officer 12345NA
8. Did the officer give you an item/ complaint number for your complaint? YESNO  
9. Do you feel that an adequate amount of time was spent handling your complaint? YESNO If no, please explain  
10. Were you satisfied with the outcome of this matter? YESNO 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? YESNO 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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