The Office of the Ombuds Evaluation Form Survey

We need your assistance in evaluating the effectiveness of the Office of the Ombuds. Please take a few minutes to complete the following survey. All responses will remain confidential. Thank you in advance for your participation.

Question Title

* How did you learn of the Office of the Ombuds? (check all that apply)

Personal referral

Previous visit

Website

Staff Referral

Media article

Google or internet search

Word of mouth

Government representative

Other (please specify)

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* Was it easy to find out about how to contact the Office of the Ombuds?

Yes

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* On what date did you contact the Office of the Ombuds?

Select a date

Date

Question Title

* Based on your interactions with the Office of the Ombuds, please rate your level of satisfaction. The Office of the Ombuds... (check only one per line)

	Very satisfied	Satisfied	Neutral	Unsatisfied	Very unsatisfied
was courteous and respectful.	was courteous and respectful. Very satisfied	was courteous and respectful. Satisfied	was courteous and respectful. Neutral	was courteous and respectful. Unsatisfied	was courteous and respectful. Very unsatisfied
role was explained to me.	role was explained to me. Very satisfied	role was explained to me. Satisfied	role was explained to me. Neutral	role was explained to me. Unsatisfied	role was explained to me. Very unsatisfied
responded timely to my communication (e.g., phone calls, emails, etc.).	responded timely to my communication (e.g., phone calls, emails, etc.). Very satisfied	responded timely to my communication (e.g., phone calls, emails, etc.). Satisfied	responded timely to my communication (e.g., phone calls, emails, etc.). Neutral	responded timely to my communication (e.g., phone calls, emails, etc.). Unsatisfied	responded timely to my communication (e.g., phone calls, emails, etc.). Very unsatisfied
carefully listened to my issue/concern.	carefully listened to my issue/concern. Very satisfied	carefully listened to my issue/concern. Satisfied	carefully listened to my issue/concern. Neutral	carefully listened to my issue/concern. Unsatisfied	carefully listened to my issue/concern. Very unsatisfied
understood and offered pertinent and accurate information.	understood and offered pertinent and accurate information. Very satisfied	understood and offered pertinent and accurate information. Satisfied	understood and offered pertinent and accurate information. Neutral	understood and offered pertinent and accurate information. Unsatisfied	understood and offered pertinent and accurate information. Very unsatisfied
helped to identify and evaluate options to address my issue/concern.	helped to identify and evaluate options to address my issue/concern. Very satisfied	helped to identify and evaluate options to address my issue/concern. Satisfied	helped to identify and evaluate options to address my issue/concern. Neutral	helped to identify and evaluate options to address my issue/concern. Unsatisfied	helped to identify and evaluate options to address my issue/concern. Very unsatisfied
worked to remedy the concern/issue promptly	worked to remedy the concern/issue promptly Very satisfied	worked to remedy the concern/issue promptly Satisfied	worked to remedy the concern/issue promptly Neutral	worked to remedy the concern/issue promptly Unsatisfied	worked to remedy the concern/issue promptly Very unsatisfied

Question Title

* Overall, I am satisfied with the Office of the Ombuds, regardless of the outcome of my issue/situation. (check only one)

Strongly agree

Agree

Neutral

Disagree

Strongly agree

Agree

Neutral

Disagree

Strongly agree

Question Title

* If you did not have the option to correspond with the Office of the Ombuds about your issue/concern, what action would you have taken? (check all that apply)

Nothing, remain unsatisfied

Wait until a later date to address

File a lawsuit, grievance, or compliant

Leave FCPS

Address directly through a formal channel (i.e., principal, supervisor, Human Resources, FCPS Board, etc.)

Other (please specify)

Question Title

* What was the result of your communication with the Office of the Ombuds? (check all that apply)

The Office of the Ombuds acted and the issue/concern was addressed.

The Office of the Ombuds coached me to manage the issue/concern.

I withdrew my issue/concern.

I was referred to someone else.

Question Title

* If you received coaching or a referral, did it assist you in resolving your issue/concern?

Yes

N/A

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* What is the likelihood you would recommend the Office of the Ombuds? (check only one)

Very likely

Likely

Neutral

Unlikely

Very unlikely

Very likely

Likely

Neutral

Unlikely

Very unlikely

The Office of the Ombuds Evaluation Form

Question Title

* How did you learn of the Office of the Ombuds? (check all that apply)

Question Title

* Was it easy to find out about how to contact the Office of the Ombuds?

Question Title

* On what date did you contact the Office of the Ombuds?

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* Based on your interactions with the Office of the Ombuds, please rate your level of satisfaction. The Office of the Ombuds... (check only one per line)

Question Title

* Overall, I am satisfied with the Office of the Ombuds, regardless of the outcome of my issue/situation. (check only one)

Question Title

* If you did not have the option to correspond with the Office of the Ombuds about your issue/concern, what action would you have taken? (check all that apply)

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* What was the result of your communication with the Office of the Ombuds? (check all that apply)

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* If you received coaching or a referral, did it assist you in resolving your issue/concern?

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* What is the likelihood you would recommend the Office of the Ombuds? (check only one)

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* How did the Office of the Ombuds help?

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* What would you suggest for improvement?

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* Additional comments: