Annex A
Republic of the Philippines
Department of Education
Client/Citizens Satisfaction Survey Form
Control No.: ______________
Your experience matters to us!
Ang imong kasinatian mahinungdanon alang kanamo!
I. Client Information (Impormasyon sa Kliyente)
Name (Optional)
Pangalan (Opsyonal)
Office visited
Opisinang gibisita
Person Transacted With:
Kawani na Nakatransaksyon
Service/s received
Serbisyong datawat
Date Visited
Petsa ng Pagbisita
Contact details
II. Client Satisfaction Rating
Kindly rate the quality of service provided by checking the appropriate box. Leave as blank if the criterion is not applicable for the service.
(Butangi og tsek ( ) ang kahon nga nagpakita sa imong kasinatian mahitungod sa serbisyong nadawat.)
CRITERIA
Very Dissatisfied
Wala gayod
Nakauyon
Dissatisfied
Wala Nakauyon
Neutral
Satisfied
Nakauyon
Very Satisfied
Nakauyon
Kaayo
(1)
(2)
(3)
(4)
(5)
1. RESPONSIVENESS (PAGPAKABANA)
Willingness to help, assist, and provide prompt service (Paghatag og paspas nga serbisyo)
2. RELIABILITY (PAGSALIG)
Provision of what was needed and what was promised, in accordance with the policy and standards,
with zero to a minimal error rate (Pagtuman sa mga saad ug paghatag sa mga kinahanglanon uyon
sa nahisgotang sumbanan)
3. ACCESS & FACILITIES (LOKASYON UG MGA PASILIDAD)
Convenience of location, ample amenities for a comfortable transaction, and the use of clear
signages and modes of technology (Hinanaling pagtultol sa mga lugar ug hinanaling kahumanan sa
katuyoan pinaagi sa tin-aw o klaro nga mga giya)
4. COMMUNICATION (PAKIGHINABI)
Act of keeping citizens and businesses informed in a language they can easily understand, as well
as listening to their feedback (Pakighinabi ug pagpaminaw sa mga yangungo gamit ang
pinulungang masabtan sa tanan)
5. COSTS (MGA GASTO)
Satisfaction with the timeliness of the billing, billing process/es, preferred methods of payment
period, value for money, acceptable range of costs, and qualitative information on the cost of each
service (Katagbawan sa serbisyong nadawat ilabi na kon mahitungod sa mga gastohan o
gipangbayaran)
6. INTEGRITY (PAKIG-UNONG)
Capability of frontline staff/s to perform their duties, product and service knowledge, understanding
client needs, helpfulness, and good work relationships (Katakos sa pag-alad pinaagi sa
pagkamasinabtanon, pagmatinabangon ug pagpakighigala)
7. ASSURANCE (KASALIGAN)
Assurance that there is honesty, justice, fairness, and trust in each service while dealing with the
clients and businesses (Kasiguroan sa pagkamatinud-anon, kaangayan sa pagsalig sa pag-alagad
sa mga katawhan)
8. OUTCOME (ANG SANGPOTANAN)
Rate in terms of achieving outcomes or realizing the intended benefits of the service (Gradohi ang
kinatibuk-ang serbisyo o benepisyo na nadawat)
III. Suggestions/Compliments/Comments (Sugyot/Pagdayeg/Komentaryo)
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Thank you for your valuable input to help us continuously improve our services!
Daghang salamat sa imong matinud-anon ug bilihong tubag. Kining tanan alang sa kalambuan sa among pag-alagad!
Privacy Notice:
The personal information included in this document should only be used for the
purposes of administering the survey. Any personal information included herein may
not be used for other purposes aside from those stated above.
Privacy Notice:
Ang personal na impormasyon sa dokumentong ito ay maaari lamang gamitin para sa
layunin ng survey na ito. Hindi ito maaaring gamitin sa iba pang layunin maliban sa
nabanggit.