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1. Date of the Feedback (Required.)

Date

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

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3. What department do you work in?

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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. (Required.)

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5. What category best describes your feedback? (Required.)

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6. What was the date, time and duration of the incident? (Required.)

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

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

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

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

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

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12. What other information would you like to share? (Required.)

0 of 12 answered
 

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