Professional Documents
Culture Documents
QUESTIONNAIRE
NUMBER
(To be filled out by the
UP NEC personnel)
RESPONDENT INFORMATION
Respondent Name Respondent Phone
Number (House)
Position of Respondent in Respondent Phone
the Water District Number (Mobile)
Respondent Address
Date Accomplished
QUALITY CONTROL CHECKS AND VALIDATIONS
(To be filled out by the UP NEC personnel)
Witnessed/validated by Edited By
Witness/Validation Date: Date of Editing
Signature Signature
Quality Checked by Data Punched by
Quality Check Date Data Punch Date
Signature Signature
Observed by (IA) Cleared by (IA)
Observation Date Clearing Date
Signature Signature
Back-Checked by Re-screened by
Backcheck Date Rescreening Date
Signature Signature
Please encircle the corresponding code(s) for service(s) availed of by your Water District from
LWUA for the Year 2021 only.
Q1. Please use this rating scale where 5 means Very Satisfied, 4 means Satisfied, 3 means Neither
Satisfied nor Dissatisfied, 2 means Dissatisfied and 1 means Very Dissatisfied. How would you rate
the overall services of LWUA? Please encircle your corresponding rating.
VERY VERY
SATISFIED NEITHER DISSATISFIED N/A
SATISFIED DISSATIFIED
Overall
satisfaction 5 4 3 2 1 99
rating
Q3. Using this rating scale (5 - strongly agree, 4 - agree, 3 - neither agree nor disagree, 2 -
disagree and 1 - strongly disagree), please let us know how much you agree or disagree with the
following statements. Please encircle your corresponding rating.
Neither
Strongly Agree Strongly Not
Agree Disagree
Agree Nor Disagree Applicable
Disagree
Staff and organization
LWUA’s staff…
treats customers with respect 5 4 3 2 1 99
Reportorial/documentary 5 4 3 2 1 99
requirements are reasonable
Timeline for compliance are fair 5 4 3 2 1 99
and reasonable
Fees and/or penalties imposed are 5 4 3 2 1 99
fair and reasonable
Regulatory – Application with LWUA
is user-friendly 5 4 3 2 1 99
Facilities
Q4. Where do you most often get information about LWUA and its services? (Check all the applies)
INFORMATION SOURCE
Information desk
Website
Phone/Hotline
Social Media (Specify )
Conferences
Text/SMS
Bulletins
Others (Specify )
Q5. What are your suggestions for the improvement of LWUA services?