Document Code

REPUBLIC OF THE PHILIPPINES

FM-SP-07-02
DEPARTMENT OF THE INTERIOR AND LOCAL Rev. No. Eff. Date Page

GOVERNMENT (DILG) P 02 10.09.20 1 of 1

CUSTOMER SATISFACTION SURVEY FORM

(To be accomplished by DILG Personnel)

Name of Office/Operating Unit: DILG San Pablo
DILG REGION IX - ZAMBOANGA DEL SUR SURVEY MODE:
Name of Service Provided (Pangalan sa Serbisyong ibinigay): ○ In Person
LGU DTP FORMULATION WORKSHOP
___________________________________________________________________________________________________ ○ Electronics
Name of Action Officer (If applicable): _____________________________________

Dear Client (Minamahal naming Kliyente),

We at DILG- IX endeavors to consistently provide effective and efficient services to meet our client’s needs. In this regard, may we
request you to help us improve our services by allowing us to hear your voice.
(Kami, sa DILG- IX ay lubos na nagsisikap upang patuloy na magbigay ng epektibo at mataas na kalidad na serbisyo upang matugunan
ang mga pangangailangan ng aming mga kliyente. Sa bagay na ito, aming hinihiling na kami ay iyong matulungan sa patuloy na
pagpapabuti ng aming mga serbisyo sa pamamagitan ng pag-papaalam sa amin ng inyong mga saloobin.)
Kindly fill-up this survey form and reflect your impressions about our services and let us know your experience while transacting
official business with us. Shade the rating that corresponds to your satisfaction level and/or write your observations/comments.
(Kung maari lamang pong pakipunan itong Sarbey at ilahad ang inyong masasabi sa aming naibigay na serbisyo. Itiman ang bilog na
katumbas ng numero na tutugma sa inyong antas ng kasiyahan.)

RATING SCALE
(5) (4) (3) (2) (1)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Lubos na Sumasang ayon Sumasangayon o Hindi Lubos na hindi
sumasang ayon hindi sumasangayon Sumasang ayon sumasang ayon

A. SERVICE DIMENSIONS
5 4 3 2 1
ResponsivenessThe service was willingly and promptly extended to the client/customer.
Maagap na naibibigay ang serbisyo sa kliyente.
Reliability Performed the service within the expectations of the client/customer served.
Naisagawa ang serbisyo ayon sa inaasahan ng kliyente.
Access & Facilities/resources/modes of technology were readily available for convenient
Facilities transactions.
May maayos at angkop na pasilidad at sistema para sa serbisyo.
Communication Materials associated with the service are easily understood and feedback mecha-
nisms are present relevant to the client’s concern.
May sapat na impormasyon na madaling maunawaan at may mekanismo para
matugunan ang mga puna o mungkahi
Costs Value for money spent on services rendered.
Tama ang kaukulang bayad para sa serbisyo o iba pang gastos para sa transaksyon.
○
service is free of charge not applicable
Integrity Provided services with high morale and spirit of honesty.
Naglingkod nang may katapatan at mataas na integridad.
Assurance The service was provided by competent personnel.
Naibigay ang serbisyo nang may sapat na kakayahan at kaalaman.
Outcome The overall expectations of the client are met.
Nakamit ang kabuuang serbisyong inaasahan.

B. SUGGESTION FOR IMPROVEMENT

Mga mungkahi at obserbasyon para sa pagpapabuti ng serbisyo

_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________

Name of Client (Optional): __________________________ Contact Number (Optional): ___________________ Date Accomplished: _________________

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Privacy Statement

DILG is committed to protecting your privacy. Any information gathered using this tool will be treated with utmost confidentiality and shall be solely used to improve our services being provided to the
public. Thank you very much.

Ang DILG ay nangangako na protektahan ang iyong privacy. Anumang impormasyong natipon gamit ang sarbeyl na ito ay ituturing na lubos na pagiging kompidensiyal at gagamitin lamang upang
mapabuti ang aming mga serbisyo. Maraming salamat.
 Document Code
REPUBLIC OF THE PHILIPPINES
FM-SP-07-02
DEPARTMENT OF THE INTERIOR AND LOCAL Rev. No. Eff. Date Page

GOVERNMENT (DILG) P 02 10.09.20 2 of 1

CUSTOMER SATISFACTION SURVEY FORM

(To be accomplished by DILG Personnel)

Name of Office/Operating Unit: DILG REGION
San Pablo
IX - ZAMBOANGA DEL SUR SURVEY MODE:
Name of Service Provided (Pangalan sa Serbisyong ibinigay): ○ In Person
LGU DTP FORMULATION WORKSHOP
___________________________________________________________________________________________________ ○ Electronics
Name of Action Officer (If applicable): _____________________________________

Dear Client (Minamahal naming Kliyente),

We at DILG- IX endeavors to consistently provide effective and efficient services to meet our client’s needs. In this regard, may we
request you to help us improve our services by allowing us to hear your voice.
(Kami, sa DILG- IX ay lubos na nagsisikap upang patuloy na magbigay ng epektibo at mataas na kalidad na serbisyo upang matugunan
ang mga pangangailangan ng aming mga kliyente. Sa bagay na ito, aming hinihiling na kami ay iyong matulungan sa patuloy na
pagpapabuti ng aming mga serbisyo sa pamamagitan ng pag-papaalam sa amin ng inyong mga saloobin.)
Kindly fill-up this survey form and reflect your impressions about our services and let us know your experience while transacting
official business with us. Shade the rating that corresponds to your satisfaction level and/or write your observations/comments.
(Kung maari lamang pong pakipunan itong Sarbey at ilahad ang inyong masasabi sa aming naibigay na serbisyo. Itiman ang bilog na
katumbas ng numero na tutugma sa inyong antas ng kasiyahan.)

RATING SCALE
(5) (4) (3) (2) (1)
Strongly Agree Agree Neutral Disagree Strongly Disagree
Lubos na Sumasang ayon Sumasangayon o Hindi Lubos na hindi
sumasang ayon hindi sumasangayon Sumasang ayon sumasang ayon

B. SERVICE DIMENSIONS
5 4 3 2 1
Responsiveness The service was willingly and promptly extended to the client/customer.
Maagap na naibibigay ang serbisyo sa kliyente.
Reliability Performed the service within the expectations of the client/customer served.
Naisagawa ang serbisyo ayon sa inaasahan ng kliyente.
Access & Facilities/resources/modes of technology were readily available for convenient
Facilities transactions.
May maayos at angkop na pasilidad at sistema para sa serbisyo.
Communication Materials associated with the service are easily understood and feedback mecha-
nisms are present relevant to the client’s concern.
May sapat na impormasyon na madaling maunawaan at may mekanismo para
matugunan ang mga puna o mungkahi
Costs Value for money spent on services rendered.
Tama ang kaukulang bayad para sa serbisyo o iba pang gastos para sa
transaksyon.
○
service is free of charge not applicable
Integrity Provided services with high morale and spirit of honesty.
Naglingkod nang may katapatan at mataas na integridad.
Assurance The service was provided by competent personnel.
Naibigay ang serbisyo nang may sapat na kakayahan at kaalaman.
Outcome The overall expectations of the client are met.
Nakamit ang kabuuang serbisyong inaasahan.

B. SUGGESTION FOR IMPROVEMENT

Mga mungkahi at obserbasyon para sa pagpapabuti ng serbisyo

_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________

Name of Client (Optional): __________________________ Contact Number (Optional): ___________________ Date Accomplished: _________________

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Privacy Statement

DILG is committed to protecting your privacy. Any information gathered using this tool will be treated with utmost confidentiality and shall be solely used to improve our services being provided to the
public. Thank you very much.

Ang DILG ay nangangako na protektahan ang iyong privacy. Anumang impormasyong natipon gamit ang sarbeyl na ito ay ituturing na lubos na pagiging kompidensiyal at gagamitin lamang upang
mapabuti ang aming mga serbisyo. Maraming salamat.