Child Abuse Prevention Customer Survey

1. Agency Name:
2. Report:
3. Fiscal Year:

Section A: Descriptive Information

Include a copy of the instrument used with the first monthly report of the fiscal year (July).
4. Survey data is solicited:
5. Percent of clients/customers served for which data was sought:
6. Number of surveys solicited this month:
7. Number of surveys completed/returned this month:
Section B: Statistical Data

This section should include year-to-date information only.
8. Number of surveys solicited year-to-date:
9. Number of surveys completed/returned year-to-date:
Overall Survey Data
10. Number satisfied with service provided:
11. Number not satisfied with service provided:
12. Number indicating a combination of both satisfied and not satisfied responses.
13. Number where satisfaction could not be determined.
Survey Statistics
14. Number completed/returned indicating satisfied or not satisfied with service provided (7 plus 8):
15. Percent satisfied with service provided - DCS goal is 85% (7 divided by 11):
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