Derry Fire Ambulance Service Survey

1. Derry Fire Department EMS Division Customer Satisfaction Survey

We're committed to monitoring the quality of the services provided by the EMS Division of the Derry Fire Department. As part of an ongoing improvement process, we would appreciate your feedback on our performance. (All submissions are anonymous.)If you would like to talk directly to the Director of EMS, please call 603-432-6751.

1. WERE YOU THE PATIENT?

WERE YOU THE PATIENT? YES

PARENT OR GUARDIAN

AUTHORIZED REPRESENTATIVE

OTHER

2. WHAT IS YOUR AGE GROUP?

WHAT IS YOUR AGE GROUP? < 18

1) 18-30

2) 31-50

3) 50-65

4) 65-80

5) > 80

3. WHAT WAS THE LOCATION OF THE EMERGENCY?

WHAT WAS THE LOCATION OF THE EMERGENCY? 1) DERRY

2) AUBURN

3) CHESTER

4) OTHER

4. WHAT TYPE OF EMERGENCY?

WHAT TYPE OF EMERGENCY? 1) MEDICAL/ILLNESS

2) TRAUMA/INJURY

3) N/A

5. HOW WOULD YOU RATE THE RESPONSE TIME OF THE AMBULANCE OR FIRE TRUCK?

HOW WOULD YOU RATE THE RESPONSE TIME OF THE AMBULANCE OR FIRE TRUCK? EXCELLENT

GOOD

ADEQUATE

POOR

UNACCEPTABLE

N/A

6. HOW WOULD YOU RATE THE AMBULANCE OR FIRE CREWS ABILITIES TO EXPLAIN WHAT THEY WERE DOING AND WHY?

HOW WOULD YOU RATE THE AMBULANCE OR FIRE CREWS ABILITIES TO EXPLAIN WHAT THEY WERE DOING AND WHY? EXCELLENT

GOOD

ADEQUATE

POOR

UNACCEPTABLE

N/A

7. HOW WOULD YOU RATE THE PROFESSIONALISM OF THE AMBULANCE OR FIRE CREWS?

HOW WOULD YOU RATE THE PROFESSIONALISM OF THE AMBULANCE OR FIRE CREWS? EXCELLENT

GOOD

ADEQUATE

POOR

UNACCEPTABLE

N/A

8. THE TIMELINESS AND QUALITY OF OUR EMS PROVIDERS RESPONSE TO YOUR NEEDS?

THE TIMELINESS AND QUALITY OF OUR EMS PROVIDERS RESPONSE TO YOUR NEEDS? EXCELLENT

GOOD

ADEQUATE

POOR

UNACCEPTABLE

N/A

9. OVERALL, HOW WOULD YOU RATE OUR PERFORMANCE?

OVERALL, HOW WOULD YOU RATE OUR PERFORMANCE? EXCELLENT

GOOD

ADEQUATE

POOR

UNACCEPTABLE

N/A

10. BASED ON OUR PERFORMANCE, HOW CONFIDENT ARE YOU IN REQUESTING OUR SERVICES AGAIN IN THE FUTURE?

BASED ON OUR PERFORMANCE, HOW CONFIDENT ARE YOU IN REQUESTING OUR SERVICES AGAIN IN THE FUTURE? VERY CONFIDENT

CONFIDENT

SOMEWHAT CONFIDENT

NOT CONFIDENT

NOT AT ALL CONFIDENT

11. IF WERE NOT SATISFIED WITH SERVICE PROVIDED PLEASE TELL US WHY. IF YOU WOULD LIKE SOMEONE FROM THE FIRE DEPARTMENT TO CALL YOU TO DISCUSS YOUR EXPERIENCE, PLEASE LEAVE YOUR CONTACT INFORMATION.

IF WERE NOT SATISFIED WITH SERVICE PROVIDED PLEASE TELL US WHY. IF YOU WOULD LIKE SOMEONE FROM THE FIRE DEPARTMENT TO CALL YOU TO DISCUSS YOUR EXPERIENCE, PLEASE LEAVE YOUR CONTACT INFORMATION.

12. ANY SUGGESTIONS ON HOW WE CAN IMPROVE OUR SERVICE?

ANY SUGGESTIONS ON HOW WE CAN IMPROVE OUR SERVICE?

13. PLEASE PROVIDE SUGGESTIONS OR ADDITIONAL INFORMATION SO THAT WE CAN IMPROVE SERVICE PROVIDED.

PLEASE PROVIDE SUGGESTIONS OR ADDITIONAL INFORMATION SO THAT WE CAN IMPROVE SERVICE PROVIDED.