Polson Fire Department
Feedback Form
Please fill out this form completely.
Date of incident
Location
1. Did the Fire Department respond in a timely manner
Please Choose
Yes
No
2. Was the crew that responded to your emergency helpful and courteous
Please Choose
Very
Somewhat
Average
Not Very
Not At All
3. Did the Fire Department personnel take time to explain their actions
Please Choose
Yes
No
4. Was the care/help you received appropriate
Please Choose
Very
Somewhat
Average
Not Very
Not At All
5. Were the services that you believe should have been performed, that were not
Please Choose
Yes
No
What were the services not provided
6. What type of emergency did you have?
Please Choose
Fire
Medical
Accident
Rescue
7. Were our volunteers easily identified as fire/rescue personnel
Please Choose
Yes
No
8. How would you rate your overall satisfaction with the service you received from the Polson Fire Department
Please Choose
Completely Satisfied
Somewhat Satisfied
Not Very Satisfied
Not Satisfied At All
9. Would you like a Fire Department representative to contact you in regards to your incident
Please Choose
Yes
No
Name
Phone
Comments
Thank you for taking the time to fill this out to help us provide a better service for our community.