ESDHD Customer Service Survey

Question Title

1. Date you used the East Shore District Health Department (ESDHD) services:

Date

Question Title

2. I interacted with the health department as a ______________.

Private citizen

Developer, Contractor, Engineer, Builder, Surveyor, Septic Installer or Well Driller

Restaurant /Food Service Owner or Operator or Food Truck Owner or Operator or Temporary Food Vendor

Hair Dresser, Barber. Salon owner, Masseuse, Tattoo Parlor owner or employee

Landlord

Real Estate Agent

Participant in Nurturing Family Network Program

Receiving vaccine or clinical services

participated in a health education program

Other (please specify)

Question Title

3. What town do you work or live in? (Please pick the town that brings you in contact with ESDHD)

Branford

East Haven

North Branford/Northford

Other (please specify)

Question Title

4. When was your last significant interaction with ESDHD?

In the last 30 days

In the past year

In 2016 or earlier

Other (please specify)

Question Title

5. Name of the person who helped you (if you know):

Question Title

6. Purpose of visit:

Question Title

7. How or where was your last significant interaction with ESDHD?

In-person in the field

In-person in my home or place of business

In-person at ESDHD

By telephone

By US mail

By email

Via website

Other (please specify)

Question Title

8. What is your preferred method of contact?

In-person

Phone

US mail

FAX

Text message

Social media

Other (please specify)

Question Title

9. Please indicate your level of agreement with the following statements

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	N/A
Staff allowed me time for my questions or issues of concern.	Staff allowed me time for my questions or issues of concern. Strongly Agree	Staff allowed me time for my questions or issues of concern. Agree	Staff allowed me time for my questions or issues of concern. Neutral	Staff allowed me time for my questions or issues of concern. Disagree	Staff allowed me time for my questions or issues of concern. Strongly Disagree	Staff allowed me time for my questions or issues of concern. N/A
Staff effectively answered all questions asked.	Staff effectively answered all questions asked. Strongly Agree	Staff effectively answered all questions asked. Agree	Staff effectively answered all questions asked. Neutral	Staff effectively answered all questions asked. Disagree	Staff effectively answered all questions asked. Strongly Disagree	Staff effectively answered all questions asked. N/A
I was greeted in a timely manner.	I was greeted in a timely manner. Strongly Agree	I was greeted in a timely manner. Agree	I was greeted in a timely manner. Neutral	I was greeted in a timely manner. Disagree	I was greeted in a timely manner. Strongly Disagree	I was greeted in a timely manner. N/A
I understand what was explained to me.	I understand what was explained to me. Strongly Agree	I understand what was explained to me. Agree	I understand what was explained to me. Neutral	I understand what was explained to me. Disagree	I understand what was explained to me. Strongly Disagree	I understand what was explained to me. N/A
The staff members listened to me carefully.	The staff members listened to me carefully. Strongly Agree	The staff members listened to me carefully. Agree	The staff members listened to me carefully. Neutral	The staff members listened to me carefully. Disagree	The staff members listened to me carefully. Strongly Disagree	The staff members listened to me carefully. N/A
I received all the services or information I needed.	I received all the services or information I needed. Strongly Agree	I received all the services or information I needed. Agree	I received all the services or information I needed. Neutral	I received all the services or information I needed. Disagree	I received all the services or information I needed. Strongly Disagree	I received all the services or information I needed. N/A

Question Title

10. Based on your last significant contact, please rate ESDHD on the following factors:

	Excellent	Very Good	Good	Poor
Professionalism	Professionalism Excellent	Professionalism Very Good	Professionalism Good	Professionalism Poor
Courtesy	Courtesy Excellent	Courtesy Very Good	Courtesy Good	Courtesy Poor
Adequate Advice	Adequate Advice Excellent	Adequate Advice Very Good	Adequate Advice Good	Adequate Advice Poor
Overall Customer Service	Overall Customer Service Excellent	Overall Customer Service Very Good	Overall Customer Service Good	Overall Customer Service Poor

Question Title

11. Do you access the ESDHD website, Facebook page or Twitter?

Yes

Question Title

12. Please let us know how we can improve our services:

Question Title

13. Would you use expanded web-based online services (permits status tracking, application submittal, fee payments, forms for any clinical services) as a way to work with ESDHD?

Yes

Maybe

Don’t know

Other (please specify)

ESDHD Customer Service Survey

Question Title

1. Date you used the East Shore District Health Department (ESDHD) services:

Question Title

2. I interacted with the health department as a ______________.

Question Title

3. What town do you work or live in? (Please pick the town that brings you in contact with ESDHD)

Question Title

4. When was your last significant interaction with ESDHD?

Question Title

5. Name of the person who helped you (if you know):

Question Title

6. Purpose of visit:

Question Title

7. How or where was your last significant interaction with ESDHD?

Question Title

8. What is your preferred method of contact?

Question Title

9. Please indicate your level of agreement with the following statements

Question Title

10. Based on your last significant contact, please rate ESDHD on the following factors:

Question Title

11. Do you access the ESDHD website, Facebook page or Twitter?

Question Title

12. Please let us know how we can improve our services:

Question Title

13. Would you use expanded web-based online services (permits status tracking, application submittal, fee payments, forms for any clinical services) as a way to work with ESDHD?

Question Title

14. What issues or trends should your local health department be planning for in the next three to five years?

Question Title

15. Do you have any additional comments about the East Shore District Health Department's customer service?

Question Title

16. Would you like us to follow-up with you regarding this survey? If so, please include your contact information below:

Question Title

* 1. Date you used the East Shore District Health Department (ESDHD) services:

Question Title

* 2. I interacted with the health department as a ______________.

Question Title

* 3. What town do you work or live in? (Please pick the town that brings you in contact with ESDHD)

Question Title

* 4. When was your last significant interaction with ESDHD?

Question Title

* 5. Name of the person who helped you (if you know):

Question Title

* 6. Purpose of visit:

Question Title

* 7. How or where was your last significant interaction with ESDHD?

Question Title

* 8. What is your preferred method of contact?

Question Title

* 9. Please indicate your level of agreement with the following statements

Question Title

* 10. Based on your last significant contact, please rate ESDHD on the following factors:

Question Title

* 11. Do you access the ESDHD website, Facebook page or Twitter?

Question Title

* 12. Please let us know how we can improve our services:

Question Title

* 13. Would you use expanded web-based online services (permits status tracking, application submittal, fee payments, forms for any clinical services) as a way to work with ESDHD?

Question Title

* 14. What issues or trends should your local health department be planning for in the next three to five years?

Question Title

* 15. Do you have any additional comments about the East Shore District Health Department's customer service?

Question Title

* 16. Would you like us to follow-up with you regarding this survey? If so, please include your contact information below:

1. Date you used the East Shore District Health Department (ESDHD) services:

2. I interacted with the health department as a ______________.

3. What town do you work or live in? (Please pick the town that brings you in contact with ESDHD)

4. When was your last significant interaction with ESDHD?

5. Name of the person who helped you (if you know):

6. Purpose of visit:

7. How or where was your last significant interaction with ESDHD?

8. What is your preferred method of contact?

9. Please indicate your level of agreement with the following statements

10. Based on your last significant contact, please rate ESDHD on the following factors:

11. Do you access the ESDHD website, Facebook page or Twitter?

12. Please let us know how we can improve our services:

13. Would you use expanded web-based online services (permits status tracking, application submittal, fee payments, forms for any clinical services) as a way to work with ESDHD?

14. What issues or trends should your local health department be planning for in the next three to five years?

15. Do you have any additional comments about the East Shore District Health Department's customer service?

16. Would you like us to follow-up with you regarding this survey? If so, please include your contact information below: