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

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25. Submit

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