Rural Community Installation Feedback Survey
Please provide your feedback on the recent installation in your community. Your input helps us improve our services.
Your Full Name
*
First Name
Last Name
Your Role in the Community
*
Please Select
Resident
Community Leader
Maintenance Staff
Other
Contact Email Address
*
example@example.com
Installation Location (Village or Area Name)
*
Type of Installation
*
Please Select
Water Supply System
Solar Power System
Communication Network
Sanitation Facility
Other
Installation Completion Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate the overall quality of the installation?
*
1
2
3
4
5
Please rate your satisfaction with the following aspects:
*
Rows
Timeliness
Communication
Workmanship
Safety
Cleanliness
Very Dissatisfied
1
2
3
4
5
Dissatisfied
6
7
8
9
10
Neutral
11
12
13
14
15
Satisfied
16
17
18
19
20
Very Satisfied
21
22
23
24
25
Did you experience any issues with the installation?
*
No issues encountered
Minor issues (resolved)
Major issues (unresolved)
Please describe any issues or concerns you experienced (if any)
What improvements would you suggest for future installations?
Additional comments or feedback
Submit Feedback
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