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CCSS Form

This document is a citizen/client satisfaction survey form from the Department of Education in the Philippines. The form collects information about the client such as name, date and office visited, service received, and personnel involved. It then asks the client to rate various aspects of service quality on a scale from very dissatisfied to very satisfied, including responsiveness, reliability, facilities, communication, costs, integrity, assurance, and outcomes. Finally, it provides space for additional suggestions, complaints or concerns and thanks the client for their feedback to help improve services.

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KENNEDY VAGAY
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180 views

CCSS Form

This document is a citizen/client satisfaction survey form from the Department of Education in the Philippines. The form collects information about the client such as name, date and office visited, service received, and personnel involved. It then asks the client to rate various aspects of service quality on a scale from very dissatisfied to very satisfied, including responsiveness, reliability, facilities, communication, costs, integrity, assurance, and outcomes. Finally, it provides space for additional suggestions, complaints or concerns and thanks the client for their feedback to help improve services.

Uploaded by

KENNEDY VAGAY
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
Citizens/Client Satisfaction Survey Form Control No.: ______________
Your experience matters to us!
Ang iyong karanasan ay mahalaga sa amin!

I. Client Information (Impormasyon ng Kliyente)

Name Date Visited

(Pangalan ) (Petsa ng Pagbisita)

Office visited

(Opisinang binisita) Contact details

Service/s received

(Serbisyong natanggap)

Personnel Concerned

(Kinauukulang Tauhan)

II. Client Satisfaction Rating


Kindly rate the quality of service provided by checking the appropriate box. Leave as blank if the criterion is not applicable for the service.
(Lagyan ng tsek ang kahong nagsasaad ng iyong karanasan ukol sa serbisyong natanggap. Iwanang blanko ang pamantayan kung ito ay hindi angkop sa
serbisyong natanggap.)

Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied


CRITERIA
Lubhang hindi Hindi nasiyahan Nasiyahan Lubhang
nasiyahan nasiyahan

1. RESPONSIVENESS (PAGTUGON)
Willingness to help, assist, and provide prompt service (Handang tumugon at
magbigay nang mabilis na serbisyo sa kliyente)

2. RELIABILITY (MAAASAHAN)
Provision of what was needed and what was promised, in accordance with the
policy and standards, with zero to a minimal error rate (Mahusay na pagbibigay ng
serbisyo ayon sa itinakdang pamantayan)

3. ACCESS & FACILITIES (LOKASYON AT PASILIDAD)


Convenience of location, ample amenities for a comfortable transaction, and the
use of clear signages and modes of technology (Mabilis mapuntahan ang lugar at
magamit ang pasilidad sa pamamagitan nang malinaw na karatula)

4. COMMUNICATION (PAKIKIPAG-USAP)
Act of keeping citizens and businesses informed in a language they can easily
understand, as well as listening to their feedback (Pakikipag-ugnayan sa kliyente sa
paraang malinaw at nauunawaan kasama ang mga opinion at puna)

5. COSTS (GASTOS)
Satisfaction with the timeliness of the billing, billing process/es, preferred methods
of payment period, value for money, acceptable range of costs, and qualitative
information on the cost of each service (Kontento sa serbisyong natanggap at sa
halagang naging katumbas o binayaran)

6. INTEGRITY (KATAPATAN)
Capability of frontline staff/s to perform their duties, product and service knowledge,
understanding client needs, helpfulness, and good work relationships (Kasiguruhan
na gampanan ang tungkulin, na may kaalaman sa serbisyo, pag-unawa sa mga

Privacy Notice: Privacy Notice:


The personal information included in this document should only be used for the Ang personal na impormasyon sa dokumentong ito ay maaari lamang gamitin para sa
purposes of administering the survey. Any personal information included herein may layunin ng survey na ito. Hindi ito maaaring gamitin sa iba pang layunin maliban sa
not be used for other purposes aside from those stated above. nabanggit.
Republic of the Philippines
Department of Education
pangangailangan ng kliyente, matulungin, at maayos na ugnayan sa trabaho)

7. ASSURANCE (PAGTITIWALA)
Assurance that there is honesty, justice, fairness, and trust in each service while
dealing with the clients and businesses (Pagtiyak sa serbisyong may katapatan,
hustisya, patas at tiwala sa habang nakikipig- ugnayan sa kliyente)

8. OUTCOME
Rate in terms of achieving outcomes or realizing the intended benefits of the service
(Markahan ang pangkalahatang serbisyo na natanggap)

III. Suggestions/Complaints/Concerns (Suhestiyon/Reklamo/Komento)


___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
__________________________________________________________________________

Signature (Lagda): ___________________________

Thank you for your valuable input to help us continuously improve our services!
Maraming salamat sa iyong tulong para sa ikauunlad ng among serbisyo!

Privacy Notice: Privacy Notice:


The personal information included in this document should only be used for the Ang personal na impormasyon sa dokumentong ito ay maaari lamang gamitin para sa
purposes of administering the survey. Any personal information included herein may layunin ng survey na ito. Hindi ito maaaring gamitin sa iba pang layunin maliban sa
not be used for other purposes aside from those stated above. nabanggit.

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