Fire Department Customer Service Survey

Welcome!

Hampton Fire & Rescue takes great pride in the service we provide to you and the community. We are constantly seeking ways to improve service to our customers. To assist us, we ask that you evaluate our level of service by completing this survey.

We thank you for the opportunity to assist you. As your fire department, we are always here for you!
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Please tell us the following:

	MM		DD		YYYY
Date of Service	Please tell us the following: Date of Service Month	/	Day	/	Year

Reason for Visit:

Reason for Visit: Fire

Emergency Medical Services

Investigation

Inspection

Public Education

Home Safety Survey/Smoke Detector Installation

Other (please specify)

Name of representative (s) that assisted you:

Please rate each of the following:

	1 - Outstanding	2 - Good	3 - Fair	4 - Poor
Positive attitude:	Please rate each of the following: Positive attitude: 1 - Outstanding	2 - Good	3 - Fair	4 - Poor
Appearance:	Appearance: 1 - Outstanding	2 - Good	3 - Fair	4 - Poor
Representative was courteous:	Representative was courteous: 1 - Outstanding	2 - Good	3 - Fair	4 - Poor
Resolved issues:	Resolved issues: 1 - Outstanding	2 - Good	3 - Fair	4 - Poor
Overall satisfaction:	Overall satisfaction: 1 - Outstanding	2 - Good	3 - Fair	4 - Poor

Please provide any additional comments / suggestions:

(Optional Information)

(Optional Information) Name:
Address:
ZIP Code:
Email Address:
Phone Number:

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