Emergency Service Unit Survey
Help us improve our emergency services by providing your feedback on your recent experience.
Your Full Name
First Name
Last Name
Your Contact Email
example@example.com
Which emergency service unit are you evaluating?
*
Please Select
Police
Fire Department
Ambulance/EMS
Rescue Team
Other
Date and time of the incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
How did you contact the emergency service unit?
*
Phone call (emergency number)
Online request
Walk-in/On-site
Other
Please rate the following aspects of the emergency service unit:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Response time
1
2
3
4
5
Professionalism of staff
6
7
8
9
10
Communication and information provided
11
12
13
14
15
Equipment and vehicle condition
16
17
18
19
20
Overall satisfaction
21
22
23
24
25
How long did it take for the emergency unit to arrive?
*
Please Select
Less than 10 minutes
10-30 minutes
31-60 minutes
More than 1 hour
Not applicable
Did the emergency service unit resolve your issue?
*
Yes, completely
Partially
No
Not applicable
Would you recommend this emergency service unit to others?
*
Yes
No
Not sure
Please provide any additional comments or suggestions for improvement.
Submit Survey
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