Responsive Works Feedback Survey

• Address

• Conducted on

  Date

• Prepared by

• Date issue reported to AHS

  Date

• Date when works were completed

  Date

• Were you given notice of when an AHS operative would attend?

  Yes

  No

  N/A

• Did the operative introduce themselves and explain what work was to be undertaken?

  Yes

  No

  N/A

• Was the operative polite and courteous?

  Yes

  No

  N/A

• Was the operative wearing AHS uniform?

  Yes

  No

  N/A

• Was the work completed first time?

  Yes

  No

  N/A

• Was a return visit required?

  Yes

  No

  N/A

• Was a return visit date provided?

  Yes

  No

  N/A

• Was the work area left clean and tidy?

  Yes

  No

  N/A

• Was the work completed to your expectation?

  Yes

  No

  N/A

• Was waste from the works removed?

  Yes

  No

  N/A

Feedback

• In your opinion was the work completed in a safe manner?

  Yes

  No

  N/A

• Regarding response works. Do you have any comments / suggestions that AHS could consider to improve their service?

• Would you like a copy of this report?

  Yes

  No

  N/A

• Would you mind if a member of AHS contacted you regarding your feedback?

  Yes

  No

  N/A

Signature

• Please sign:

  Sign

• Date:

  Date