Maritime Safety and Security

United States Coast Guard

Maritime Safety and Security Customer Satisfaction Report
Select Activity Type *

Select Local USCG Unit or Nearest Port *

Other Activity

First Name:

Last Name:

Email:

Phone Number:

Vessel or Facility Name:

Vessel or Facility Official Number:

Select Country of Registry (If applicable)

Company Name

Company Position

* Required Fields
Based on the activity type selected above, please select the applicable box to
the right.

Perception of the Customer
Strongly
Strongly
Disagree Neutral Agree
N/A
Disagree
Agree

The purpose and process of the USCG activity was explained clearly
I was/we were treated with dignity and respect
Form(s) issued to me clearly identified the applicable regulation(s) for which
I was cited as noncompliant
USCG activity results and any item(s) requiring further coordination were
fully explained and mutually understood
USCG officials were professional and knowledgeable
Local ports and waterways are safe, secure, and clean
Homeport content (e.g., contact info, resources) is accessible and current
USCG officials were prompt with returning phone call(s), e-mail(s), and
scheduling
Additional remarks for strongly disagreeing:

Additional remarks for strongly agreeing:

Suggestions for how we can serve you better:

Yes

No

Please indicate if you would like a USCG representative to contact you (If yes, please ensure that you provide your e-mail or
telephone number at the top)
Best time to contact you
Reset

Thank you for taking time to complete this survey; we value your feedback in directly helping the USCG ensure the highest level of commitment and service to the
maritime industry and public.
This is a voluntary survey form with OMB No.: 1625-0080, and Expires: mm/dd/yyyy
MPS-FM-MPS-01 (02)