Satisfaction Survey Indicate Type of Service Received:Fire/SmokeMedical AidAnnual or Semi-Annual InspectionPublic ServicePermit InspectionPlan ReviewOtherPlease Specify: At Address/Location: Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Time: Hours : Minutes AM PM AM/PM Date: MM slash DD slash YYYY The Fire Department Responded Promptly: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Fire Department Personnel Were Courteous: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Fire Department Personnel Were Helpful: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Fire Department Personnel Were Professional in Appearance: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Overall, I Was Satisfied With the Fire Department's Service: Strongly Agree Agree Disagree Strongly Disagree Not Applicable I Was Satisfied With the Ambulance Service: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Permit/Plan Submittal Requirements Were Given or Explained: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Plans Reviewed Within an Acceptable Time: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Phone Operator Was Efficient and Courteous: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Return Calls Were Made Promptly: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Inspection Was Scheduled Within an Acceptable Time: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Inspector Arrived on Time: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Inspector Explained Code Requirements and Answered Questions: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Inspector Explained Code Deficiencies: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Inspector Was Courteous and Professional: Strongly Agree Agree Disagree Strongly Disagree Not Applicable Overall, the Level of Service Was Good Strongly Agree Agree Disagree Strongly Disagree Not Applicable Additional Comments or Suggestions for Fire Service Improvements:I Would Like to Speak to a Fire Department Representative: Yes No Name: Phone:Best Time to Call: Hours : Minutes AM PM AM/PM Δ
