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[agcyNm]

Customer Satisfaction Survey

The [agcyNm] ([agcy]) is committed to providing the highest quality of service to our customers. To help us improve our services, please complete this survey. In completing the survey, please consider the quality of the services provided -- from your initial contact with the Commission through the investigations process (if applicable). If you have any questions, please call [agcyPhn]. Thank you for your help with this survey.

NOTE: Responses will not be provided to the investigator prior to completion of the investigation of your complaint.

[agcy] Case #: ___________	[agcy] Employee’s Name: ______________________________________

Return your completed survey to: [agcyNm] [agcyAddy] [agcyCity], [abbr] [agcyZip] Person completing survey (X appropriate response):

___ Complainant/Complainant Representative

___ Respondent Representative

Please fill in the O by your response.

INTAKE PROCESS
Upon initial contact with the Commission, the Intake staff’s courtesy, professionalism and helpfulness were:
5 - Excellent O	4 - Very Good O	3 - Good O	2 - Neutral O	1 - Poor O	N/A O
Upon initial contact with the Commission, the Intake staff’s knowledge and ability to assist me were:
5 - Excellent O	4 - Very Good O	3 - Good O	2 - Neutral O	1 - Poor O	N/A O
INVESTIGATIONS PROCESS
The investigator’s courtesy, professionalism and helpfulness were:
5 - Excellent O	4 - Very Good O	3 - Good O	2 - Neutral O	1 - Poor O	N/A O
The investigator’s knowledge and ability to assist me throughout the investigations process were:
5 – Excellent O	4 – Very Good O	3 – Good O	2 – Neutral O	1 – Poor O	N/A O
The investigator’s written and verbal communication skills were:
5 – Excellent O	4 – Very Good O	3 Good O	2 - Neutral O	1 – Poor O	N/A O
The investigator’s timely responses to phone calls, e-mails and other correspondence were:
5 – Excellent O	4 – Very Good O	3 Good O	2 - Neutral O	1 – Poor O	N/A O
Please rate your overall experience with the [agcy]:
5 – Excellent O	4 – Very Good O	3 Good O	2 - Neutral O	1 – Poor O	N/A O

Please provide any other comments or suggestions that may help us in improving our services:

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BUY™	SELL™	SHOP™
Downloaded From www.TextBookDiscrimination.com
SELL YOUR OWN TEMPLATES (help others get the justice that they deserve)
BUY™	SELL™	SHOP™