FEEDBACK FORM
 
Customer Name
Period Year Month
 
Customer's Perception  
1. Quality of service  
a. Accuracy of condition survey
1 2 3 4 5
b. Competence of personnel
1 2 3 4 5
c. Condition matched as that of survey report?
1 2 3 4 5
d. Overall Quality of reports submitted
1 2 3 4 5
2. Timely service        
a. Is survey done on time
1 2 3 4 5
b. Timely reporting & commutation
1 2 3 4 5
3. Overall        
a. Value addition of the Service Provided by the Organisation
1 2 3 4 5
b. Past experience of performance & Overall opinion
1 2 3 4 5
4. Bench marking        
How would you rate our service levels as agents other surveyors used by you.
1 2 3 4 5
 
Any suggestion you would like to give in order to service better for enhance our service level.
 
Customer Signature  
Rating Criteria on scale of 1 to 5 Excellent 5 out of 5, Very Good 4, Good 3, Satisfactory 2, Poor 1.
Office Use Only        
Customer Profile        
Turnover given by customer (%)
Potential of customer (% share of his Business)
         

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