Feedback Survey

Hello from the Plainfield Fire Protection District. You have recently had contact with our organization, and we hope our service met or exceeded your expectations. The following is a brief, simple questionnaire concerning the assistance we offered you. To aide us in providing the highest quality service, we would appreciate your answers and comments on this form. Please feel free to call me if you have any immediate concerns. Thank you for taking the time to complete this survey. Your feedback helps us to improve the service to our citizens.

    How did the District serve you?

    Ambulance Service (Not Auto Accident)Motor Vehicle CrashFire AlarmCarbon Monoxide CallStructure FirePublic Service/AssistanceFire Prevention (Inspection, Plan Review, Permit, Etc)Public Education (Presentations, Special Events, Etc)Other

    1. Courtesy

    A. The District member(s) listened to the problems of the patient or occupant.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments:

    B. The District member(s)showed respect (dignity of the patient or property of the occupant).

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    C. The District member(s) acted in a professional manner.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    2. Job Skills

    A. The District member(s) worked well as a team.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    B. The District member(s)were knowledgeable and thorough about your problem.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    C. The patient or occupant was kept informed during the incident.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    Overview

    A. Quality of Service during and after the incident.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    B. Timeliness of service; response - during care - during transport.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    C. Professionalism and appearance of District member(s).

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    D. Overall Satisfaction.

    Exceeded ExpectationsAs ExpectedLess Than Expected

    Comments

    Would you like to be contacted by someone from the Plainfield Fire Protection District regarding this questionnaire? If so, please provide us with your name and phone number below. Thank you for your time!

    Name: (Optional)

    Phone Number: (Optional)