Name

Email Address

Address

Contact No

Age

Sex SexMALEFEMALE

Religion

Agency Visited Agency VisitedMAYOR'S OFFICEMAYOR'S STAFFADMINISTRATOR'S OFFICEENGINEERING'S OFFICEMPDOHRMOSB OFFICETREASURY OFFICEBUDGET OFFICEACCOUNTING OFFICELCR OFFICEASSESSOR'S OFFICEMDRRMCDEPARTMENT OF AGRICULTURE'S OFFICEMSWDOBIRTHING HOMEDILGPESO OFFICERURAL HEALT UNIT 1RURAL HEALT UNIT 2PANIQUI GENERAL HOSPITAL

Service Availed

Customer Type Customer TypeCitizenBusinessGovernment

Do you know about the Citizen’s Charter (document of an agency’s services and reqs.)? Do you know about the Citizen’s Charter (document of an agency’s services and reqs.)? Yes, aware before my transaction with this office Yes, but aware only when I saw the CC of this office No, not aware of the CC

Did you see this office’s Citizen’s Charter? Did you see this office’s Citizen’s Charter? Yes, the CC was easy to find Yes, but the CC was hard to find No, I did not see this office’s CC

Did you use the Citizen’s Charter as a guide for the service/s you availed? Did you use the Citizen’s Charter as a guide for the service/s you availed? Yes, I was able to use the CC No, I was not able to use the CC

No, I was not able to use the CC because

I spent an acceptable amount of time to complete my transaction (Responsiveness) I spent an acceptable amount of time to complete my transaction (Responsiveness) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

The office accurately informed and followed the transaction’s requirements and steps (Reliability) The office accurately informed and followed the transaction’s requirements and steps (Reliability) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

My online transaction (including steps and payment) was simple and convenient (Access and Facilities) My online transaction (including steps and payment) was simple and convenient (Access and Facilities) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

I easily found information about my transaction from the office or its website (Communication) I easily found information about my transaction from the office or its website (Communication) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

I paid an acceptable amount of fees for my transaction (Costs) I paid an acceptable amount of fees for my transaction (Costs) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

I am confident my online transaction was secure (Integrity) I am confident my online transaction was secure (Integrity) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

The office's online support was available, or (if asked questions) online support was quick to respond (Assurance) The office's online support was available, or (if asked questions) online support was quick to respond (Assurance) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

I got what I needed from the government office (Outcome) I got what I needed from the government office (Outcome) Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree

Remarks