Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
Health Facilities Enhancement Program - Management Office

Respondent No.: _____________

CUSTOMER SATISFACTION SURVEY

(Health Facilities Enhancement Program)

In pursuit of service excellence, we would like to solicit your assessment on satisfaction and comments/suggestions
on the implementation of Health Facilities Enhancement Program. We will appreciate it if you can spend moment to
answer this survey form. Thank you very much!
Date: __________________________

Indicators Excellen Very Good Good Satisfactory Poor

t
Assistance/needs provided as requested
Equipment
Reliability (ability to perform its required
functions)
Usability (ease of use, user-friendly)
Maintainability (easy to maintain)
Durability (ability to withstand wear, pressure, or
damage)
Overall rating
Infrastructure/Civil Works
Name of Project/Facility:
Location:
Allocation:
Funding Source (HFEP/BUB):
Implementing Agency (DOH/DPWH/LGU):
Safety (condition of being protected from harm or
other non-desirable outcomes)
Space (desirable minimum area requirements met)
Design (conformance to planning and design)
Quality of Materials (rate over-all appearance
and satisfaction based on plan and program of
works)
Overall rating

Suggestions / recommendations:

Respondent's Profile:
Name: __________________________________________________
Office/Health Facility: ______________________________________
Complete Address: ________________________________________
Tel. No. / CP No.: ________________________________________
Email Address: __________________________________________