Delivery Impact Assessment Form

Delivery Impact Assessment Form
Please complete this form to assess the impact and effectiveness of the recent delivery operation.
Delivery Reference Number*
Date of Delivery*
MonthDayYear
Date
Delivery Location (Address)*
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Recipient Name*
First NameLast Name
Type of Delivery*
Please rate the following aspects of the delivery:*
Rows Poor Fair Good Very Good Excellent
Timeliness
Condition of Goods
Professionalism of Delivery Staff
Communication Prior to Delivery
Overall Satisfaction
No, everything went smoothlyYes, minor issuesYes, significant issuesOther (please specify)
How would you rate the environmental impact of this delivery?*

1
2
3
4
5
1 is Low Impact, 5 is High Impact
How would you rate the delivery's impact on the local community (e.g., traffic, noise, disruption)?*

1
2
3
4
5
1 is No Impact, 5 is Major Impact
Additional Comments or Suggestions
Should be Empty:

Rows	Poor	Fair	Good	Very Good	Excellent
Timeliness
Condition of Goods
Professionalism of Delivery Staff
Communication Prior to Delivery
Overall Satisfaction