1. Helped very much 3.

Did not help

2. Somewhat helped 4. N/A

Republic of the Philippines

Department of Education
REGION IV-A
DIVISION OF GENERAL TRIAS CITY
GENERAL GREGORIO S. ALONA SR. MEM. ELEM.
SCHOOL

HELP US SERVE YOU BETTER!

This Client Satisfaction Measurement (CSM) tracks the customer’s HELP US SERVE YOU BETTER!
experiences on government office services. Your feedback on your recently
concluded transaction will help this office provide a better service. Personal This Client Satisfaction Measurement (CSM) tracks the customer’s
information shared will be kept confidential. You always have option to not experience on government office services. Your feedback on your recently
answer this form. concluded transaction will help this office provide a better service. Personal
information shared will be kept confidential. You always have option to not
Client type: Citizen Business Government (Employee or
answer this form.
another agency)
Client type: Citizen Business Government (Employee or
Date: _______________ Sex: Male Female Age: ______ another agency)
Place of residence: ______________________ Service Availed: Date: _______________ Sex: Male Female Age: ______
___________
______________________________________________________________________ Place of residence: ______________________ Service Availed:
INSTRUCTIONS: Check mark ( ) your answer to the Citizen’s Charter ___________
(CC) questions. The Citizen’s Charter is an official document that reflects ______________________________________________________________________
the services of a government agency/ office including its requirements, INSTRUCTIONS: Check mark ( ) your answer to the Citizen’s Charter
fees, and processing times among others. (CC) questions. The Citizen’s Charter is an official document that reflects
the services of a government agency/office including its requirements, fees,
CC1 Which of the following best describes your awareness of a CC?
and processing times among others.
1. I know what a CC is and I saw this office’s CC.
2. I know what a CC is but I did NOT see this office’s CC. CC1 Which of the following best describes your awareness of a CC?
3. I learned of the CC only when I saw this office’s CC. 1. I know what a CC is and I saw this office’s CC.
4. I do not know what a CC is and I did not see one this office. 2. I know what a CC is but I did NOT see this office’s CC.
(Answer ‘N/A’ on CC2 and CC3) 3. I learned of the CC only when I saw this office’s CC.
CC2 If aware of CC (answered 1-3 in CC1), would you say that the CC of this 4. I do not know what a CC is and I did not see one this office.
office (Answer ‘N/A’ on CC2 and CC3)
was …? CC2 If aware of CC (answered 1-3 in CC1), would you say that the CC of this
1. Easy to see 4. Not visible at all office
2. Somewhat easy to see 5. N/A was …?
3. Difficult to see 1. Easy to see 4. Not visible at all
CC3 If aware of CC (answered codes 1-3 in CC1), how much did the CC help 2. Somewhat easy to see 5. N/A
you in 3. Difficult to see
your transaction?
CC3 If aware of CC (answered codes 1-3 in CC1), how much did the CC help government office, or (if
you in denied) denial of
your transaction? request was sufficiently
1. Helped very much 3. Did not help explained to me.
2. Somewhat helped 4. N/A Suggestions on how we can further improve our services (optional):
____________________________________________________________________________
________________________________________________________________
INSTRUCTIONS: Email address (optional): _____________________________________
For SQD 0-8, please put a check mark ( ) on the column that best THANK YOU!
corresponds to your answer. INSTRUCTIONS:
For SQD 0-8, please put a check mark ( ) on the column that best
corresponds to your answer.
N/A
Strongl Agree Neither Disagre Strongl
y Agree Agree e y
Not N/A
Applicab
nor Disagre Strongl Agree Neither Disagre Strongl
le Not
Disagree e y Agree Agree e y Applicabl
SQD0. I am satisfied nor Disagre e
with the service that I Disagree e
availed. SQD0. I am satisfied
SQD1. I spent a with the service that I
reasonable amount of availed.
time for my transaction. SQD1. I spent a
SQD2. The office reasonable amount of
followed the time for my transaction.
transaction’s SQD2. The office
requirements and steps followed the
based on the transaction’s
information provided. requirements and steps
SQD3. The steps based on the
(including payment) I information provided.
needed to do for my SQD3. The steps
transaction were easy (including payment) I
and simple. needed to do for my
SQD4. I easily found transaction were easy
information about my and simple.
transaction from the SQD4. I easily found
office or its website. information about my
SQD5. I paid a transaction from the
reasonable amount of office or its website.
fees for my transaction. SQD5. I paid a
SQD6. I feel the office reasonable amount of
was fair to everyone, or fees for my transaction.
“walang palakasan”,
SQD6. I feel the office
during my transaction.
was fair to everyone, or
SQD7. I was treated “walang palakasan”,
courteously by the during my transaction.
staff, and (if asked for
help) the staff was SQD7. I was treated
helpful. courteously by the staff,
SQD8. I got what I and (if asked for help)
needed from the the staff was helpful.
 SQD8. I got what I
needed from the
government office, or (if
denied) denial of
request was sufficiently
explained to me.
Suggestions on how we can further improve our services (optional):
____________________________________________________________________________
________________________________________________________________
Email address (optional): _____________________________________
THANK YOU!