Question Title

* 1. Date of the Feedback

Date

Question Title

* 2. What is your name?
(If anonymous, please write, "Anonymous")

Question Title

* 3. What department do you work in?

Question Title

* 4. What is the best way to initially contact you to follow up on this feedback?  Please provide contact information for the County to follow up on this feedback.

Question Title

* 5. What category best describes your feedback?

Question Title

* 6. What was the date, time and duration of the incident?

Question Title

* 7. Tell us about your feedback.  Describe the situation leading you to provide the County with feedback.

Question Title

* 8. What did the County do well in this situation?

Question Title

* 9. What could the County have done to improve our performance?

Question Title

* 10. How did the situation affect you, the team, the organization or the community?

Question Title

* 11. How would you like to see this situation resolved?

Question Title

* 12. What other information would you like to share?

0 of 12 answered
 

T