INTERNAL CUSTOMER FEEDBACK FORM

Raised on
Issuing Department/Section Name/Designation
(Date/Time)
Completed on
Service Provided by Name/Designation
Date/Time

Check (  ) As Appropriate
Agree Neutral Disagree
ATTRIBUTES N/A
3 2 1
Initial Response was swift
Staff was courteous and helpful
Written and/or verbal communications were clear and precise
Requested status was updated timely
Received Product/Service was in compliance with specified perimeters
Quantity was received as per plan
Product/Service delivery was on time
I am satisfied with the quality of the work
Safety measures were observed during the activity
Agree Neutral Disagree
ADDITIONAL ATTRIBUTES (use if necessary) N/A
3 2 1

Score Obtained Out of Percentage Performance Matrix

0-44% Poor Performance
Note: Final score to be tallied against the total number of attributes for which a score has been given. 45-74% Average Performance
N/A attributes will be excluded. 75-100% Good Performance

REMARKS FROM ISSUING DEPARTMENT/SECTION

Signature/Date

RESPONSE FROM SERVICE PROVIDER (If any) Agree Disagree

Signature/Date