Republic of the Philippines

Department of Education

Republic of the Philippines Citizens/Client Satisfaction Survey Form Control No.: ____________
Department of Education Your experience matters to us!
Ang iyong karanasan ay mahalaga sa amin!
Citizens/Client Satisfaction Survey Form Control No.: ____________ I. Client Information (Impormasyon ng Kliyente)
Your experience matters to us! Name (Optional) Date Visited
Ang iyong karanasan ay mahalaga sa amin! Pangalan (Opsyonal) ________________________________________________________________ Petsa ng Pagbisita _______________________________
I. Client Information (Impormasyon ng Kliyente) Office visited
Name (Optional) Date Visited Opisinang binisita ________________________________________________________________ Contact Details _______________________________
Pangalan (Opsyonal) ________________________________________________________________ Petsa ng Pagbisita _______________________________ Service/s received
Office visited Serbisyong natanggap ________________________________________________________________________________________________________________
Opisinang binisita ________________________________________________________________ Contact Details _______________________________ II. Client Satisfaction Rating
Service/s received Kindly rate the quality of service provided by checking the appropriate box. Leave as blank if the criterion is not applicable for the service.
Serbisyong natanggap ________________________________________________________________________________________________________________ (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.)
II. Client Satisfaction Rating
Dissatisfied Neutral Very Satisfied
Kindly rate the quality of service provided by checking the appropriate box. Leave as blank if the criterion is not applicable for the service.
Hindi nasiyahan Satisfied Lubhang
(Lagyan ng tsek ang kahong nagsasaad ng iyong karanasan ukol sa serbisyong natanggap. Iwanang blanko ang pamantayan kung ito ay hindi angkop sa serbisyong Nasiyahan nasiyahan
natanggap.) CRITERIA Very Dissatisfied
Dissatisfied Very Satisfied Lubhang hindi
Hindi nasiyahan Satisfied Lubhang nasiyahan
Nasiyahan nasiyahan 1. RESPONSIVENESS (PAGTUGON)
CRITERIA Very Dissatisfied Neutral
Willingness to help, assist, and provide prompt service (Handang tumugon at magbigay
Lubhang hindi
nasiyahan nang mabilis na serbisyo sa kliyente)
1. RESPONSIVENESS (PAGTUGON) 2. RELIABILITY (MAAASAHAN)
Willingness to help, assist, and provide prompt service (Handang tumugon at magbigay Provision of what was needed and what was promised, in accordance with the policy and
nang mabilis na serbisyo sa kliyente) standards, with zero to a minimal error rate (Mahusay na pagbibigay ng serbisyo ayon sa
itinakdang pamantayan)
2. RELIABILITY (MAAASAHAN)
Provision of what was needed and what was promised, in accordance with the policy and
3. ACCESS & FACILITIES (LOKASYON AT PASILIDAD)
standards, with zero to a minimal error rate (Mahusay na pagbibigay ng serbisyo ayon sa Convenience of location, ample amenities for a comfortable transaction, and the use of
itinakdang pamantayan) clear signages and modes of technology (Mabilis mapuntahan ang lugar at magamit ang
pasilidad sa pamamagitan nang malinaw na karatula)
3. ACCESS & FACILITIES (LOKASYON AT PASILIDAD)
Convenience of location, ample amenities for a comfortable transaction, and the use of
4. COMMUNICATION (PAKIKIPAG-USAP)
clear signages and modes of technology (Mabilis mapuntahan ang lugar at magamit ang Act of keeping citizens and businesses informed in a language they can easily understand,
pasilidad sa pamamagitan nang malinaw na karatula) as well as listening to their feedback (Pakikipag-ugnayan sa kliyente sa paraang malinaw
at nauunawaan kasama ang mga opinion at puna)
4. COMMUNICATION (PAKIKIPAG-USAP)
Act of keeping citizens and businesses informed in a language they can easily understand,
5. COSTS (GASTOS)
as well as listening to their feedback (Pakikipag-ugnayan sa kliyente sa paraang malinaw Satisfaction with the timeliness of the billing, billing process/es, preferred methods of
at nauunawaan kasama ang mga opinion at puna) 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
5. COSTS (GASTOS) katumbas o binayaran)
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
6. INTEGRITY (KATAPATAN)
the cost of each service (Kontento sa serbisyong natanggap at sa halagang naging Capability of frontline staff/s to perform their duties, product and service knowledge,
katumbas o binayaran) understanding client needs, helpfulness, and good work relationships (Kasiguruhan na
gampanan ang tungkulin, na may kaalaman sa serbisyo, pag-unawa sa mga
6. INTEGRITY (KATAPATAN) pangangailangan ng kliyente, matulungin, at maayos na ugnayan sa trabaho)
Capability of frontline staff/s to perform their duties, product and service knowledge,
understanding client needs, helpfulness, and good work relationships (Kasiguruhan na
7. ASSURANCE (PAGTITIWALA)
gampanan ang tungkulin, na may kaalaman sa serbisyo, pag-unawa sa mga Assurance that there is honesty, justice, fairness, and trust in each service while dealing
pangangailangan ng kliyente, matulungin, at maayos na ugnayan sa trabaho) with the clients and businesses (Pagtiyak sa serbisyong may katapatan, hustisya, patas at
tiwala sa habang nakikipig- ugnayan sa kliyente)
7. ASSURANCE (PAGTITIWALA)
Assurance that there is honesty, justice, fairness, and trust in each service while dealing
8. OUTCOME
with the clients and businesses (Pagtiyak sa serbisyong may katapatan, hustisya, patas at Rate in terms of achieving outcomes or realizing the intended benefits of the service
tiwala sa habang nakikipig- ugnayan sa kliyente) (Markahan ang pangkalahatang serbisyo na natanggap)
8. OUTCOME III. Suggestions/Complaints/Concerns (Suhestiyon/Reklamo/Komento)
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)
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________ __________________________
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
Thank you for your valuable input to help us continuously improve our services! purposes of administering the survey. Any personal information included herein may sa layunin ng survey na ito. Hindi ito maaaring gamitin sa iba pang layunin maliban
Maraming salamat sa iyong tulong para sa ikauunlad ng among serbisyo! not be used for other purposes aside from those stated above. sa nabanggit.
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
purposes of administering the survey. Any personal information included herein may sa layunin ng survey na ito. Hindi ito maaaring gamitin sa iba pang layunin maliban
not be used for other purposes aside from those stated above. sa nabanggit.