Republic of the Philippines Republic of the Philippines Republic of the Philippines

Department of Education Department of Education Department of Education

Region IX Region IX Region IX
DIVISION OF DAPITAN CITY DIVISION OF DAPITAN CITY DIVISION OF DAPITAN CITY
CUSTOMER FEEDBACK FORM CUSTOMER FEEDBACK FORM CUSTOMER FEEDBACK FORM
Please let us know how we have served you. This form maybe used for compliments, Please let us know how we have served you. This form maybe used for compliments, Please let us know how we have served you. This form maybe used for compliments,
suggestions and/or complaints. The contents shall be kept confidential and shall be used for suggestions and/or complaints. The contents shall be kept confidential and shall be used for suggestions and/or complaints. The contents shall be kept confidential and shall be used for
internal evaluation of our services. internal evaluation of our services. internal evaluation of our services.
Name of Client (Optional): _______________________________ Date: ____________ Name of Client (Optional): _______________________________ Date: ____________ Name of Client (Optional): _______________________________ Date: ____________
Purpose of Transaction: ____________________________________________________ Purpose of Transaction: ____________________________________________________ Purpose of Transaction: ____________________________________________________
Time Started: ________ Time Ended: ________ Remarks: ______________________ Time Started: ________ Time Ended: ________ Remarks: ______________________ Time Started: ________ Time Ended: ________ Remarks: ______________________
Name & Signature of Employee Transacted with: ______________________________ Name & Signature of Employee Transacted with: ______________________________ Name & Signature of Employee Transacted with: ______________________________
Section/Office (Please Check). Section/Office (Please Check). Section/Office (Please Check).
Office of SDS Education Facilities Procurement(BAC) Records Unit Office of SDS Education Facilities Procurement(BAC) Records Unit Office of SDS Education Facilities Procurement(BAC) Records Unit
Office of ASDS SMME Legal Service Personnel Unit Office of ASDS SMME Legal Service Personnel Unit Office of ASDS SMME Legal Service Personnel Unit
CID (EPS & PSDS) Planning & Research Accounting Unit Payroll Service CID (EPS & PSDS) Planning & Research Accounting Unit Payroll Service CID (EPS & PSDS) Planning & Research Accounting Unit Payroll Service
LRMS School Health and Budget Unit Cash Unit LRMS School Health and Budget Unit Cash Unit LRMS School Health and Budget Unit Cash Unit
Nutrition Nutrition Nutrition
SGOD Youth Formation Administrative Service Supply Unit SGOD Youth Formation Administrative Service Supply Unit SGOD Youth Formation Administrative Service Supply Unit
Social Mobilization DRRM General Services ICT Social Mobilization DRRM General Services ICT Social Mobilization DDRM General Services ICT

OVERALL SATISFACTION OF SERVICE OVERALL SATISFACTION OF SERVICE OVERALL SATISFACTION OF SERVICE

Quality of Service Quality of Service Quality of Service
Extremely Very Extremely Extremely Very Extremely Extremely Very Extremely
Dissatisfied Dissatisfied Satisfied Satisfied Satisfied Dissatisfied Dissatisfied Satisfied Satisfied Satisfied Dissatisfied Dissatisfied Satisfied Satisfied Satisfied
(1) (2) (3) (4) (5) (1) (2) (3) (4) (5) (1) (2) (3) (4) (5)

Courtesy Courtesy Courtesy

Promptnes Promptnes Promptnes

s s s

Initiative Initiative Initiative

Efficiency Efficiency Efficiency

Quality of Facilities Quality of Facilities Quality of Facilities

Cleanliness Cleanliness Cleanliness

Comfort Comfort Comfort

Orderliness Orderliness Orderliness

Safety Safety Safety

We would like to hear your comments and suggestions with anything so we can We would like to hear your comments and suggestions with anything so we can We would like to hear your comments and suggestions with anything so we can
improve our services. improve our services. improve our services.
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Customer’s Signature (Optional):_________________ Contact No. ________________ Customer’s Signature (Optional):_________________ Contact No. ________________ Customer’s Signature (Optional):_________________ Contact No. ________________
OSDS-ADMS-F03, Rev. 02, Eff. OSDS-ADMS-F03, Rev. 02, Eff. OSDS-ADMS-F03, Rev. 02, Eff.