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COMMUNITY INFORMATION
CUSTOMER SERVICE COMMENT FORM
Circle with X Welcome to our online customer comment section. We provide this as a means for those we serve, to let us know how we are doing. By taking the time to complete a customer service comment, we can change the ways we provide service to our community.

SERVICE DATE:

What type of service was provided to you?
 EDUCATIONAL PRESENTATION
 FIRE EMERGENCY
 FIRE STATION TOUR
 GENERAL ASSISTANCE
 MEDICAL EMERGENCY
 RESCUE EMERGENCY
OTHER: 

If we responded to an emergency,
do you feel the response time was adequate?   Yes  No

Based on the service we provided to you, please rate that service using the categories listed below.
PROFESSIONALISM:
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
COURTESY:
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
EFFICIENCY:
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
HELPFULNESS:
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
KNOWLEDGE:
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
OVERALL SERVICE:
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR

If you visited one of our facilities, please indicate below which facility you visited.
BRITTON LOOP
ADMINISTRATION CLASSROOM
TRAINING FACILITIES
EAST BAKER VIEW STATION
AGATE BAY STATION
OTHER: 

Regarding the facility you visited, please rate the facility in the areas listed below.
LOCATION: 
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
ACCESSIBILITY: 
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
CONDITION: 
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
PARKING: 
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR
SIGNAGE: 
EXCEPTIONAL      ABOVE AVERAGE      SATISFACTORY      POOR

What other services or programs would you like Fire District 4 to offer?

If you would like to be contacted by a Fire Department Representative regarding our services, please provide us the following information.
NAME:
ADDRESS:
CITY/STATE/ZIP:
 
PHONE NUMBER:
EMAIL:

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