CLIENT FEEDBACK FORM ON PROGRAM IMPLEMENTERS / SERVICE PROVIDERS

In our effort to continually improve the delivery of our programs and services, we give great value to your feedback.

All information/responses will be treated with strict confidentiality.

Thank you.

POLO Tokyo

Email: polotokyo.feedback@gmail.com

Address: 5-15-5 Roppongi, Minato-Ku, Tokyo 106-0032

Question Title

* 1. Personal Information

Full Name (Optional)

Date (Required)

Question Title

* 2. Prefecture

Other (please specify)

Question Title

* 3. Gender

Question Title

* 4. Name of POLO-Tokyo Officer / Personnel

Question Title

* 5. Type of Services / Transactions availed:

General Inquiry

Balik-Manggagawa (BM)

Verification of Employment Documents

Request for Welfare Assistance

OWWA Membership

Other (please specify)

Question Title

* 6.
4 - Excellent
3 - Very Satisfactory
2 - Satisfactory
1 - Unsatisfactory

Please choose the number that best describes your assessment of the program / service availed of and the quality of our facilities.

I. EFFICIENCY OF SERVICES
The Service was:

	4	3	2	1
Provided on Time	Provided on Time 4	Provided on Time 3	Provided on Time 2	Provided on Time 1
Provided Courteously	Provided Courteously 4	Provided Courteously 3	Provided Courteously 2	Provided Courteously 1
Accommodating and Polite	Accommodating and Polite 4	Accommodating and Polite 3	Accommodating and Polite 2	Accommodating and Polite 1

Question Title

* 7.
II. EFFECTIVENESS

	4	3	2	1
Responded to your needs	Responded to your needs 4	Responded to your needs 3	Responded to your needs 2	Responded to your needs 1
Information is Clear and Undertandable	Information is Clear and Undertandable 4	Information is Clear and Undertandable 3	Information is Clear and Undertandable 2	Information is Clear and Undertandable 1
Will you recommend the service to other people?	Will you recommend the service to other people? 4	Will you recommend the service to other people? 3	Will you recommend the service to other people? 2	Will you recommend the service to other people? 1

Question Title

* 8.
III. QUALITY OF FACILITIES (For walk-in clients only)

	4	3	2	1
Readable Signages	Readable Signages 4	Readable Signages 3	Readable Signages 2	Readable Signages 1
Orderliness of Receiving Area	Orderliness of Receiving Area 4	Orderliness of Receiving Area 3	Orderliness of Receiving Area 2	Orderliness of Receiving Area 1
Cleanliness of the Office Premises	Cleanliness of the Office Premises 4	Cleanliness of the Office Premises 3	Cleanliness of the Office Premises 2	Cleanliness of the Office Premises 1
Requirements for New Normal (Plastic Barrier, Alcohol , etc)	Requirements for New Normal (Plastic Barrier, Alcohol , etc) 4	Requirements for New Normal (Plastic Barrier, Alcohol , etc) 3	Requirements for New Normal (Plastic Barrier, Alcohol , etc) 2	Requirements for New Normal (Plastic Barrier, Alcohol , etc) 1
Proper Ventilation	Proper Ventilation 4	Proper Ventilation 3	Proper Ventilation 2	Proper Ventilation 1
Well-lighted Workplace	Well-lighted Workplace 4	Well-lighted Workplace 3	Well-lighted Workplace 2	Well-lighted Workplace 1

Question Title

* 9. How would you rate our services?

4 - Excellent

3 - Very Satisfactory

2 - Satisfactory

1 - Unsatisfactory

CLIENT FEEDBACK FORM ON PROGRAM IMPLEMENTERS / SERVICE PROVIDERS

Question Title

* 1. Personal Information

Question Title

* 2. Prefecture

Question Title

* 3. Gender

Question Title

* 4. Name of POLO-Tokyo Officer / Personnel

Question Title

* 5. Type of Services / Transactions availed:

Question Title

* 6. 4 - Excellent3 - Very Satisfactory2 - Satisfactory1 - UnsatisfactoryPlease choose the number that best describes your assessment of the program / service availed of and the quality of our facilities.I. EFFICIENCY OF SERVICESThe Service was:

Question Title

* 7. II. EFFECTIVENESS

Question Title

* 8. III. QUALITY OF FACILITIES (For walk-in clients only)

Question Title

* 9. How would you rate our services?

Question Title

* 10. Any comments and/or recommendations to improve our services?

* 6.
4 - Excellent
3 - Very Satisfactory
2 - Satisfactory
1 - Unsatisfactory

Please choose the number that best describes your assessment of the program / service availed of and the quality of our facilities.

I. EFFICIENCY OF SERVICES
The Service was:

* 7.
II. EFFECTIVENESS

* 8.
III. QUALITY OF FACILITIES (For walk-in clients only)