Humboldt — Form Center • Customer Satisfaction Survey Form

Source: https://www.humboldtgov.org/FormCenter/CAO-Forms-17/Customer-Satisfaction-Survey-Form-180

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Customer Satisfaction Survey Form

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Department Satisfaction Survey

Have you had an interaction with a county department and/or program you want to tell us about? Use this form to let us know how satisfactory you found that interaction.

Department Name

-- Select One --AgricultureAssessorAuditor-ControllerAviation Board of Supervisors Child Support ServicesClerk-Recorder Registrar of VotersCooperative ExtensionCounty Administrative OfficeCounty Counsel Department of Health & Human ServicesDistrict AttorneyHuman ResourcesLibraryPlanning & BuildingProbationPublic DefenderPublic WorksSheriffTreasurer-Tax Collector

Division

-- Select One --AdministrationAdult Protective ServicesBehavioral Health - Adult ServicesBehavioral Health - Children ServicesBehavioral Health - SempervirensBehavioral Health -Substance Use Disorder (SUD)Environmental HealthHousing, Outreach, Mobile Engagement (HOME)In Home Supportive Services (IHSS)Public AuthorityPublic GuardianPublic Health Social Services - Child Welfare Services (CWS)Social Services - Eligibility Veteran Services

Division

-- Select One --Rex Bohn - 1st DistrictMichelle Bushnell - 2nd DistrictMike Wilson - 3rd DistrictVirginia Bass - 4th DistrictSteve Madrone - 5th DistrictClerk of the Board

Division

-- Select One --Clerk RecorderElections - Registrar of Voters

Division

-- Select One --ADA ComplianceCommunicationsEconomic DevelopmentInformation Technology Management - BudgetPurchasing

Division

-- Select One --Revenue RecoveryTax CollectionTreasury

Division

-- Select One --Facilities Maintenance Fleet ServicesLand UseNatural ResourcesParks - TrailsRoadsSolid WasteTransportationWater Management

Division

-- Select One --Arcata Blue Lake BookmobileEureka FerndaleFortunaGarbervilleHoopaMcKinleyvilleTrinidad Rio DellWillow Creek

Division

-- Select One --Advance PlanningBuilding InspectionCannabis PlanningCurrent PlanningCode Enforcement

Division

-- Select One --Animal ControlCoronerCorrectional ServicesCourt ServicesCriminal InvestigationsDispatchOffice of Emergency Services

Division

-- Select One --Adult ServicesJuvenile Services

Use the link below to leave feedback for the Sheriff-Coroner's Office

Complaints and Commendations Forms

Use the link below to leave feedback for the Aviation Department

Aviation Work Order Form

Use the link below to connect with a Librarian

Connect with a Librarian Form

Use the link below to leave feedback for Child Support Services

Child Support Customer Satisfaction Survey

PLEASE NOTE: THIS IS NOT CHILD WELFARE SERVICES

Date of Interaction

Date of Interaction

Was the interaction

-- Select One --In PersonOver PhoneVia Email

1. How satisfied were you with the service you received?

Very Satisfied

Satisfied

Dissatisfied

Very Dissatisfied

2. County staff gave me complete and consistent answers:

Strongly Agree

Agree

Disagree

Strongly Disagree

3. How friendly were the employees?

Very Satisfied

Satisfied

Dissatisfied

Very Dissatisfied

4. County staff was knowledgeable in their area of responsibility and professional:

Strongly Agree

Agree

Disagree

Strongly Disagree

5. County staff responded to me in a timely manner by email/phone (Typically within 24-48 Hours)

Strongly Agree

Agree

Disagree

Strongly Disagree

6. Comments/Suggestions for the Department:

7. Would you like someone from our office to contact you regarding the service you received?

Yes

No

8. Contact Information (Optional)

Your Name (First/Last)

Phone Number

Email Address

Leave This Blank:

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Email address

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