Onsite Water Protection

2. Name of staff*

   Environmental Health Specialist who provided service

4. Type of service provided*
   -- Select One --Record Search or General InformationNew Septic System PermitSeptic System Repair PermitExisting Septic System InspectionNew Well PermitWell Repair PermitWater SampleOther:

5. Please specify is "Other" selected

7. Was the staff polite and professional?*
   -- Select One --YesNo

8. Was the staff knowledgeable about the services being provided?*
   -- Select One --YesNo

9. Did the staff provide enough education to help you understand the rules?*
   -- Select One --YesNo

11. Did the staff make it clear as to what is legally required to meet the permit issuance requirements?*
    -- Select One --YesNo

12. Did you fully understand the materials and/or information given to you?*
    -- Select One --YesNo

13. Did the staff thoroughly address your questions or concerns?*
    -- Select One --YesNo

15. Do our hours of operation meet your needs?*
    -- Select One --YesNo

16. Were you present with our staff while the service was being provided?*
    -- Select One --YesNoN/A

17. Have you had any trouble with communication to the Environmental Health office?*
    -- Select One --YesNoN/A

19. Were your calls returned promptly?*
    -- Select One --YesNoN/A

21. Please tell us how we can better improve our services:

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field