Fire Department Feedback Form

2. Cabot Fire Department Customer Survey
   Please rate your interaction 0-5 (5 being the highest)
4. Fire Department Timeliness*

   1. 0
   2. 1
   3. 2
   4. 3
   5. 4
   6. 5
5. Firefighter Professionalism*

   1. 0
   2. 1
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   4. 3
   5. 4
   6. 5
6. Firefighter Offer of Supportive Information*

   1. 0
   2. 1
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   4. 3
   5. 4
   6. 5
8. Firefighter Courtesy*

   1. 0
   2. 1
   3. 2
   4. 3
   5. 4
   6. 5
9. Restoration of Area After Emergency*

   1. 0
   2. 1
   3. 2
   4. 3
   5. 4
   6. 5
10. Overall Evaluation of Firefighter Performance*

    1. 0
    2. 1
    3. 2
    4. 3
    5. 4
    6. 5
14. Date of Your Encounter With Fire Person*
    Date of Your Encounter With Fire Person
16. Personnel Present (if available)
20. Type of Call*

    1. Medical

    1. Vehicle Accident

    1. Fire

    1. Other
22. If other please explain
26. Any Additional Comments Concerning the Firefighters of Cabot
    ex: "I was in such a daze, when the fire person recognized it and immediately called over an EMT"
28. Your Comments
32. Information About You
34. Your Name
36. Email
38. Phone Number
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42. 1. Receive an email copy of this form.
43. Email address

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44. Submit

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