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 Customer Service Homepage
----- Evaluating Customer Service/Web Base/Sample Survey
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ON YOUR ORGANIZATION'S HOMEPAGE    

     From your organization's homepage there would be a link which could be titled various ways.  Several examples are listed below and please click on one to continue.

 

 

 

 

 

 

 

     

Web
Based
Computer.gif (2833 bytes)		 CUSTOMER LINKED TO SURVEY WEB SITE
 

Welcome the Customer Survey Web Site!

(Your Organization's Logo is displayed)

     Thank you for visiting this site.  We want to hear from you.  Please complete brief questionnaire by following the instructions provided on this site.  The questionnaire takes only a few minutes to complete and your input is very important to us.

     To continue please select from the list the type of customer that best describes you.

 

 

 

 

 

 

 

 

     

AGENCY LOGO HERE

Customer Service Survey

This page may take a few moments to download to your computer.   Please do not begin the survey until the entire page has loaded.

Marking Instructions for this Section

The following items are optional.  Please take a moment and complete the following section by selecting the button corresponding to the response which generally describes yourself.

I am a: FemaleMale

My race/ethnic identification is:
African-American Hispanic-American Anglo-American
Asian-American/Pacific Islander/Native American Other

My age (in years) is:
Under 18  18-20  21-34  35-44  45-55
56-64  65 or older

Over the last year, the number of visits or contacts I have had with this agency:
1 2 - 5 More than 5

Please indicate how long you have been receiving services from this agency:
Under 1 year  1 - 5 years 6 - 10 years Over 10 years

I have lived in Texas for:
Less than 1 years 1-5 years Over 5 years

What are the first 3-digits of your home zip code

Marking Instructions for this Section

On the following statements, please indicate how strongly you agree or disagree with the statements.  Your responses can  range from strongly disagree to strongly agree.  If you do not have any information about a particular statement or the item is not applicable to you, indicate that by selecting N/A.

General Items

1. Overall, I am satisfied with the services I received.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

2. If I had other options, I would still choose to get services from this agency/institution.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Facilities

3. The location of services was convenient (parking, public transportation, distance, etc.).
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

4. The facility where I received services was clean, orderly, and easy to get around.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Staff

5. The staff were able to answer my questions.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

6. The staff were courteous.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Information

7. I received the information I needed to get services.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

8. I was given clear explanations about services available to me.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

9. I was given a clear explanation about the documentation needed to receive my service.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Internet

10. I have access to the Internet at home or work.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

11. I am able to access information about the services I need using the Internet.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Complaint Handling

12. I know how to make a complaint regarding services at this agency/institution.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

13. I believe this agency/institution will address my complaint.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Timeliness

14. Services were available at convenient times.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

15. The time I waited to receive services was reasonable.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Printed Materials

16. I have received printed information (such as brochures, handouts, books, etc.) explaining the services available.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

17. The printed information was clear and understandable.
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

Customer Type Specific Items

18. ITEM HERE
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

19. ITEM HERE
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

20. ITEM HERE
Strongly Disagree Disagree Feel Neutral Agree Strongly Agree N/A

 

STOP!

To Continue Click Here

 

The Survey of Organizational Excellence Home Page
Last Update: January 26, 2000
Questions and comments to: soe@uts.cc.utexas.edu
Copyright © Survey of Organizational Excellence. All rights reserved.

 

 

 

 

 

 

  

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CONFIRMATION
&
     APPRECIATE PAGE    

     This screens informs you that you have successfully submitted the survey and thanks the participant.  The respondent is then able to click and link back to your organization's homepage.

LINK BACK TO YOUR ORGANIZATION

    This screen may also contain information on how a customer may get in contact with your Customer Relations Representative.

Our Customer Relations Representative can be reached at j.doe@agency.state.tx.us

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Return to the
Customer Service Homepage

This Web Site is maintained by
The Survey of Organizational Excellence

Last Update:  January 26, 2000
Please direct questions and comments regarding this web site to: soe@uts.cc.utexas.edu
School of Social Work at UT Austin
Copyright © Survey of Organizational Excellence. All rights reserved.