* 1. Please list the date of the incident or event

* 2. Please list the incident number or event name if you have it

* 3. Please list the name or names of the DES personnel that provided service to you

* 4. Please check the circle that best describes your experience:

  N/A Poor Fair Good Excellent
Courtesy of the 911 call taker
Usefulness of the instructions provided by the 911 call taker
Degree to which the 911 call taker could answer your questions adequately
Quality of the phone line audio during 911 call
Professionalism/appearance of DES Emergency Medical Services personnel
Courtesy of the DES Emergency Medical Services personnel
Degree to which DES Emergency Medical Services personnel explained to you the steps they were taking during medical treatment
Quality of care provided by DES Emergency Medical Services personnel
Degree to which we removed any trash and placed furniture back the way we found it

* 5. Please write any additional comments or suggestions in the space provided below:

* 6. If a member of our staff was especially helpful, please let us know who they are so that we can recognize them for taking care of the citizens and visitors of Cecil County

T