Republic of the Philippines Republic of the Philippines

Annex "A"
Department of the Interior and Local Government Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS NATIONAL HEADQUARTERS
Agham Road, Sitio San Roque, Brgy. Bagong Pag-asa, Quezon City Agham Road, Sitio San Roque, Brgy. Bagong Pag-asa, Quezon City
Telefax Number: (02) 426 – 0219 local 507 Telefax Number: (02) 426 – 0219 local 507
Email: bfpnhq.iso9001.2015@gmail.com Email: bfpnhq.iso9001.2015@gmail.com

CUSTOMER SATISFACTION SURVEY FORM CUSTOMER SATISFACTION SURVEY FORM

Date: __________________ Date: __________________

Dear Clients, Dear Clients,
Please complete this evaluation form. Your feedback will help us improve our service. Please complete this evaluation form. Your feedback will help us improve our service.
I am a… (tick as applicable) M F Senior Citizen PWD I am a… (tick as applicable) M F Senior Citizen PWD
EXCELLENT GOOD NEEDS EXCELLENT GOOD NEEDS
Survey Questions IMPROVEMENT Survey Questions IMPROVEMENT
(3) (2) (1) (3) (2) (1)
FOR OFFICES AND STATIONS FOR OFFICES AND STATIONS
A) Cleanliness and orderliness of A) Cleanliness and orderliness of
workplace you visited workplace you visited
(Kalinisan at kaayusan sa istasyon na binisita) (Kalinisan at kaayusan sa istasyon na binisita)
B) Timeliness of the response/service B) Timeliness of the response/service
(Agarang pagtugon sa serbisyo) (Agarang pagtugon sa serbisyo)
C) Courteousness and Accommodation of C) Courteousness and Accommodation
Staff of Staff
(Magalang na pagtanggap ng bawat empleyado) (Magalang na pagtanggap ng bawat empleyado)
D) Competency and ability of the staff that D) Competency and ability of the staff
assisted you that assisted you
(Kakayahan at abilidad ng empleyado na magbigay (Kakayahan at abilidad ng empleyado na
tulong sa mga kliyente) magbigay tulong sa mga kliyente)
FOR STATIONS ONLY FOR STATIONS ONLY
E) Where you guided by the Citizen’s E) Where you guided by the Citizen’s
Charter posted in the BFP station and Charter posted in the BFP station and
are the procedures in securing Fire are the procedures in securing Fire
Safety Evaluation Clearance and Fire Safety Evaluation Clearance and Fire
Safety Inspection Certificate being Safety Inspection Certificate being
followed? followed?
(Nagabayan ka ba ng Citizen’s Charter na (Nagabayan ka ba ng Citizen’s Charter na
nakapaskil sa istasyon at nasunod ban g maayos nakapaskil sa istasyon at nasunod ban g
ang mga proseso sa pagkuha ng Fire Safety maayos ang mga proseso sa pagkuha ng Fire
Evaluation Clearance at Fire Safety Inspection Safety Evaluation Clearance at Fire Safety
Certificate?) Inspection Certificate?)
Comments and Suggestions Comments and Suggestions

___________________ _____________________ ______________ ___________________ _____________________ ______________

Visitor’s Printed Name Name of Person Visited Office Visit Visitor’s Printed Name Name of Person Visited Office Visit
(Optional) (Optional)

BFP-QSF-QMS-017 Rev. Ø1 (07.08.19) BFP-QSF-QMS-017 Rev. Ø1 (07.08.19)