Republic of the Philippines Republic of the Philippines

Department of Education Department of Education

Region 02 Region 02
Division of Tuguegarao Division of Tuguegarao
Tuguegarao West District Tuguegarao West District
CATAGGAMAN ELEMENTARY SCHOOL CATAGGAMAN ELEMENTARY SCHOOL

Date: _____________ Date: _____________

CUSTOMER FEEDBACK FORM Time In: __________ CUSTOMER FEEDBACK FORM Time In: __________

HOW DID WE SERVE YOU? HOW DID WE SERVE YOU?

Please let us know. Thanks a lot. Please let us know. Thanks a lot.

NAME: _____________________________________________ NAME: _____________________________________________

Position:________________ Office/School: _________________
Address:__________________________ CP #:_______________
II. PURPOSE OF VISIT: ________________________________
____________________________________________________
____________________________________________________
III. PERSON TO VISIT: ________________________________
Position:________________ Office/School: _________________
Address:__________________________ CP #:_______________
II. PURPOSE OF VISIT: ________________________________
____________________________________________________
____________________________________________________
III. PERSON TO VISIT: ________________________________

____________________________________________________ ____________________________________________________

III. HOW WOULD YOU RATE OUR SERVICE? ( Please put III. HOW WOULD YOU RATE OUR SERVICE? ( Please put
a check ( √ ) mark.) a check ( √ ) mark.)

4 – Outstanding 2 – Satisfactory 4 – Outstanding 2 – Satisfactory

3 – Very Satisfactory 1 – Unsatisfactory 3 – Very Satisfactory 1 – Unsatisfactory

How satisfied were you in terms of the How satisfied were you in terms of the
4 3 2 1 4 3 2 1
the service provided: the service provided:
1.response time to your transaction 1.response time to your transaction
given by the office? given by the office?
2.outcome of the service provided? 2.outcome of the service provided?
3.extensive info on / understanding of 3.extensive info on / understanding of
the service provided and/or the service provided and/or
competence/skill in delivering the competence/skill in delivering the
service? service?
4.friendliness, courteousness, fair 4.friendliness, courteousness, fair
treatment and willingness? treatment and willingness?
5.OVERALL satisfaction with regard to 5.OVERALL satisfaction with regard to
quality of service delivery? quality of service delivery?

IV.COMMENDATION(S) / RECOMMENDATION(S) / COMPLAINT / IV.COMMENDATION(S) / RECOMMENDATION(S) / COMPLAINT /

SUGGESTION(S) / DESIRED ACTION FROM OUR OFFICE? SUGGESTION(S) / DESIRED ACTION FROM OUR OFFICE?

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PROCESSING TIME PROCESSING TIME

TIME START: _______________ TIME OUT:________________ TIME START: _______________ TIME OUT:________________