Customer Satisfaction Survey Form

1
Name* This field is required.
First Name
Last Name
2
Date* This field is required.
Date
Month
Day
Year
3
Company Name / Organization / Agency* This field is required.
4
Email* This field is required.
example@example.com
5
RATING DEFINITION:

EXCEPTIONAL. Exceeds contractual requirements. The actions taken by the vendor met the contractual requirements and the scopes of services were accomplished.

SATISFACTORY. Meets contractual requirements. The actions taken by the vendor were Satisfactory.

UNSATISFACTORY. Does not meet contractual requirements, and recovery is not likely in a timely manner. The vendor’s corrective actions appear or were ineffective.

N/A. Not Applicable

INSUFFICIENT INFORMATIONTO RATE. There is not sufficient information to rate performance.
6
Product / Service Rendered* This field is required.
Learning Management System
E-Learning
Virtual Event Platform
Videoconferencing Platform
Training and Capacity Development Services
Design Services
Software License Subscription
SMS - BrandTXT
PowerBlast Customer Service Software
Website Development
Software Development
Information System Development
Professional Consultancy Services
Other
7
Work performed in compliance with contract terms* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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Materials, supplies and equipment provided as required* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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Staff availability* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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10
Timelines of work* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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11
Staff professionalism* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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12
Customer Service* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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13
Quality of work* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Rating
Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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14
Communication and accessibility* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Rating
Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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15
Prompt and effective correction of situations and conditions* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Rating
Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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16
Documentation, records, receipts, invoices and computer-generated reports received in a timely manner and in compliance with contract specifications* This field is required.
Exceptional
Satisfactory
Unsatisfactory
Not Applicable
Insufficient Info to Rate
Rating
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Exceptional
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Satisfactory
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Unsatisfactory
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Not Applicable
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Insufficient Info to Rate
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17
How likely are you to recommend our company to a colleague or friend?* This field is required.
Very likely
Somewhat likely
Unsure
Not Very Likely
Not Likely
Rating
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Very likely
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Somewhat likely
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Unsure
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Not Very Likely
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Not Likely
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18
What could we do to increase your level of satisfaction?
19
Do you have any recommendations so we can further improve our services?
20
Signature* This field is required.
Clear
21
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