Document Code: FM-CSF-02

Version No.: 0
Effectivity Date: 20-Apr-2022
DEPARTMENT OF TRADE AND INDUSTRY
DTI-10 Regional Office

CLIENT SATISFACTION FEEDBACK FORM

CONDUCT OF TRAINING | CONSUMER ADVOCACY (Orientations, Fora, Seminars, or Conferences)
TITLE OF ACTIVITY: 2023 KMME-MME Program Launching
Date/Duration: July 27, 2023 | 8AM-5PM Venue: Mallberry Suites and Business Hotel, Cagayan de Oro City
CONSENT: I hereby consent to the collection and processing by the DTI of my name, contact details, and my feedback on its services for the
purpose of monitoring, measuring, and analyzing customer feedback and of improving DTI services. I shall notify the DTI in case of any changes
in my personal information. This consent shall be valid, unless revoked or withdrawn in writing subject to the applicable provisions of the Data
Privacy Act of 2012 or Republic Act no. 10173.

Date
Client's Signature
CLIENT'S NAME:
(Title/ Prefix) (First Name) (Middle Initial) (Last Name) DESIGNATION:
(Suffix)

ADDRESS:
(House/ Building No./ Building Name) (Street Name) (City/ Municipality) (Province) (Region) (Zip code).

CONTACT NUMBER: E-MAIL ADDRESS:

PART I. Our office is committed to continually improve our services to our external clients. Please answer this Form for us to know your
feedback on the different aspects of our activity. Your feedback and impressions will help us in improving our future activities in order to better
serve our clients. Rest assured all information you will provide shall be treated with strict confidentiality.

A. Please check-mark the box that corresponds to your answer.

SEX AGE CLIENT CATEGORY SOCIAL CLASSIFICATION (if applicable)
 Male  12 - 35 years old and below  Businessperson  Abled  Youth
 Female  Above 35 - below 60 years old  Self-employed  PWD  Senior Citizen
 60 years old & above  Employed (Gov't/Private)  4Ps  Indigenous
person
 General public/Consumer  Others:  OFW
_______________________

B. For each criterion below, please check-mark the box under the column pertaining to your Rating. Mark ONE BOX ONLY for each row. For every
DISSATISFIED or VERY DISSATISFIED rating you will give, please provide reason/s in PART II below.
RATING
CRITERIA FOR RATING VERY VERY
SATISFIED DISSATISFIED
SATISFIED DISSATISFIED
1. OBJECTIVES, CONTENT, & DURATION of ACTIVITY
a. Objective/s    
b. Content or Topic    
c. Presentation materials    
c. Duration    
2. RESOURCE SPEAKER (PJ LANOT)
a. Expertise and knowledge    
b. Engagement with the participants    
c. Ability to answer questions and clarify issues    
RESOURCE SPEAKER (ADRIANO ZEN PASTORIZA)
a. Expertise and knowledge    
b. Engagement with the participants    
c. Ability to answer questions and clarify issues    
RESOURCE SPEAKER (Name of Speaker 3)
a. Expertise and knowledge    
b. Engagement with the participants    
c. Ability to answer questions and clarify issues    
3. MODERATOR's ability to manage discussion during the Open Forum    
4. HOST/SECRETARIAT's ability to provide technical/admin. assistance    
5. FOOD Quality    
6. VENUE
a. Cleanliness and provisions for sanitation    
b. Adequacy of space    
7. FACILITIES
a. Lights or lighting system    
b. Sound system    
c. Presentation facilities (projector, screen, and laptop)    
PART II. COMMENTS AND SUGGESTIONS
Please write in the space below your reason/s for your "DISSATISFIED" or "VERY DISSATISFIED" rating so that we will know in which area/s we need to
improve.

Please give comments/suggestions to help us improve our service/s:

THANK YOU!