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2. County of Louisa Department of Fire & EMS
4. Customer Satisfaction Survey
   How Was Our Service? By completing the following brief survey you can help us achieve our goal of providing excellent service to the County of Louisa.
6. Please identify your relationship with Louisa County Department of Fire and EMS.

   1. Resident
   2. Visitor
   3. Business Owner / Manager
   4. Employed within COunty Boundaries
   5. Medical Patient
   6. Fire or Rescue Victim

   1. Class / Seminar Participant
   2. Health Services Partner
   3. Public Safety Partner
   4. Government Agency Partner
   5. Public Education Partner
   6. Other
8. If Other, please specify.
12. Please indicate the reason(s) you had contact with the Louisa County Department of Fire and EMS.

    Check all that apply.

    1. Medical Response
    2. Vehicle Accident
    3. Rescue

    1. Fire Response
    2. Fire / Smoke/ Carbon Monoxide Alarm
    3. Hazardous Material Response

    1. Public Assist
    2. Fire and Life Safety Education
14. If Other, please specify
15. Date
    Date
    Please provide the approximate date that you last received services from the Louisa County Department of Fire and EMS.
19. How would you rate the PROFESSIONALISM of our employees?

    1. Exceeded my Expectations
    2. Met my Expectations

    1. Needs Improvement
    2. Did Not Meet my Expectations
21. If you selected "Needs Improvement" or "Did Not Meet my Expectations"
    Please tell us how we can improve.
25. How EFFECTIVE were our employees?

    1. Exceeded my Expectations
    2. Met my Expecations

    1. Needs Improvement
    2. Did Not Meet my Expectations
27. If you selected "Needs Improvement" or "Did Not Meet my Expectations"
    Please tell us how we can improve.
31. Overall, how would you rate the QUALITY of the services you received from the Louisa County Department of Fire and EMS?

    1. Exceeded my Expectations
    2. Met my Expectations

    1. Needs Improvement
    2. Did Not Meet My Expectations
33. If you selected "Needs Improvement" or "Did Not Meet my Expectations"
    Please tell us how we can improve.
37. Please share any final comments / suggestions.
39. Would you like someone from the Louisa County Department of Fire and EMS to contact you?

    1. Yes
    2. No
41. If you would like someone to contact you, please fill out the necessary information.
43. Name
45. Email
47. Phone Number
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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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