Republic of the Philippines

Department of Education
DISTRICT OF PANITAN
PANITAN DISTRICT OFFICE

Client/Citizens Satisfaction Survey Form Control No.:

Your experience matters to us!

Ang iyong karanasan ay mahalaga sa amin!

I. Client Information (Impormasyon ng Kliyente

Name (Optional) Date Visited

Pangalan (Opsyonal) _____________________________________ Petsa ng Pagbisita_____________________________

Office visited
Opisinang binisita _________________________________________ Contact details ________________________________

Service/s received
Serbisyong natanggap________________________________________________________________________________

II. Client Satisfaction Rating

Kindly rate the quality of service provided by checking the appropriate box. Leave as blank if the criterion is not
applicable for the service.
(Lagyan ng tsek ang kahong ngsasaad ng iyong karanasan ukol sa serbisyong natanggap. Iwanang blanko ang
pamantayan kung ito ay hindi ankop sa serbisyong natanggap.)

CRITERIA
Dissatis Ne Satis
Very Very
fied utral fied
Dissatisfied Satisfied
Hindi Nasiyahan
Lubhang hindi Lubhang
nasiyahan
nasiyahan nasiyahan
1. RESPONSIVENES (PAGTUGON)
Willingness to help, assist, and provide prompt
service (Handang tumugon at magbigay nang
mabilis na serbisyo sa kliyente)
2. RELIABILITY (MAAASAHAN)
Provision of what was needed and what was
promised, in accordance with the policy and
standards, with zero to a minimal error rate
(Mahusay na pagbigay ng serbisyo ayon sa
itinakdang pamantayan)
3. ACCESS & FACILITIES (LOKASYON AT
PASILIDAD)
Convenience of location, ample amenities for a
comfortable transaction, and the use of clear
signages and modes of technology (Mabilis
mapuntahan ang lugar at magamit ang pasilidad
sa pamamagitan nang malinaw na karatula)
4. COMMUNICATION (PAKIKIPAG-USAP)
Act of keeping citizens and businesses informed
in a language they can easily understand, as well
as listening to their feedback (Pakikipag-ugnayan
sa kliyente sa paraang malinaw at maunawaan
kasama ang mga opinion at puna)
5. COSTS ( GASTOS)
Satisfaction with the timeliness of the billing
process/es, preferred methods of payment
period, value for money, acceptable range of
costs and qualitative information on the cost of
each service (Kontento sa serbisyong natanggap
at sa halagang nagging katumbas o binayaran)
6. INTEGRITY ( KATAPATAN)
Capability of frontline staff/s to perform their
duties, product and service knowledge,
understanding client needs, helpfulness, and
good work relationships ( Kasiguruhan na
gampanan ang tungkulin, na may kaalam sa
serbisyo, pag-unawa sa mga pangangailangan ng
kliyente, matulungin, at maayos na ugnayan sa
trabaho)
7. ASSURANCE (PAGTITIWALA)
 Assurance that there is honesty, justice, fairness,
and trust in each service while dealing with the
clients and business (Pagtiyak sa serbisyong may
katapatan, hustisya, patas at tiwala sa habang
nakikipag-ugnayan sa kliyente)
8. OUTCOME
Assurance that there is honesty, justice, fairness,
and trust in each service while dealing with the
clients and businesses ( pagtiyak sa serbisyong
may katapatan, hustisya, patas at tiwala sa
habang nakikipag-ugnayan sa kliyente)

III. Suggestions/Compliments/ Comments ( Suhestiyon/Papuri/Komento)

_______________________________________________________________________________________________________________________

Thank you for you valuable input to help us continuously improve our services!
Maraming salamat sa iyong tulong para sa ikauunlad ng aming serbisyo.

Hoping for your positive response. Thank you and more

Republic
power. of the
Philippines
Department of
Education
Region I
Schools Division of San
Carlos City
Lilimasan National High
School
Lilimasan, San Carlos City,
Pangasinan
SHEILA MARIE A.
PRIMICIAS, EdD, CESO VI
Assistant Schools Division
Superintendent
Officer-in-Charge
Office of the Schools
Division Superintendent
San Carlos City,
Pangasinan
MADAM:
May I have the honor to
request your good office
that the following
COACHES/TECHNICAL
OFFICIALS of
DISTRICT V-A MEET
2023 be
granted a (2) day
Service Credit and
Compensatory Time Off
earned last
March 4-5,2023 in the
observance of the
District Meet 2023.
Attached herewith are
the following
documents: Division
Memo
049,2023, Requesting
to Conduct DISTRICT
MEET 2023, DTR,
List of
COACHES/TECHNICAL
OFFICIALS requesting
for Service Credit,
and
pictures during the said
event.
I hope for your positive
response.
Thank you and m