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Rate Your Police Service

2. The Police Department wants to know...how was our service?

4. Date of Service

5. Time of Service

7. Report/Ticket Number (optional)

8. Employee Name or Badge Number*

10. Please check the appropriate response.

12. How safe/secure do you feel in the community?*

    1. A - Very Satisfied
    2. B - Somewhat Satisfied
    3. C - Neutral
    4. D - Somewhat Dissatisfied
    5. E - Very Dissatisfied

14. Was your business handled effectively?*

    1. A - Very Satisfied
    2. B - Somewhat Satisfied
    3. C - Neutral
    4. D - Somewhat Dissatisfied
    5. E - Very Dissatisfied

16. Was the Officer/Staff courteous, professional?*

    1. A - Very Satisfied
    2. B - Somewhat Satisfied
    3. C - Neutral
    4. D - Somewhat Dissatisfied
    5. E - Very Dissatisfied

18. Overall competence of Officer/Staff?*

    1. A - Very Satisfied
    2. B - Somewhat Satisfied
    3. C - Neutral
    4. D - Somewhat Dissatisfied
    5. E - Very Dissatisfied

20. Overall Department performance*

    1. A - Very Satisfied
    2. B - Somewhat Satisfied
    3. C - Neutral
    4. D - Somewhat Dissatisfied
    5. E - Very Dissatisfied

22. What service did we provide for you?*

24. Comments or suggestions

26. Upload attachment (photo, document, etc.)

28. Would you like to be contacted?*

    1. No
    2. Yes

30. First Name

31. Last Name

33. Address

34. Apt or Suite #

35. City

37. State

38. Zip

39. Phone Number

41. Email Address

43. If you wish to receive an email copy of this form instead of printing, please check the box below and enter your email address.

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44. 1. Receive an email copy of this form.
45. Email address

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46. Submit Submit and Print

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