Evacuation Plan Satisfaction Survey
FEMA Form 007-0-13
OMB Control Number 1660-0036
Expiration ___
Public reporting burden for this survey is estimated to average 15 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the survey. You are not required to respond to this collection of information unless it displays a valid OMB control number near the title of the electronic collection instrument, or for on-line applications, on the first screen viewed by the respondents. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0036) NOTE: Do not send your completed form to this address.
The following survey is voluntary.
QUESTIONS
Introduction
Hello, I’m calling from FEMA, the Federal Emergency Management Agency. My name is ___. My ID # is _________. May I please speak with (Applicant)?
If no: Thank you for your time and have a nice day/evening. (Mark attempt)
If yes: We're looking for ways to improve the quality of our service and your opinion is very important to us.
Would you volunteer to take 3 - 7 minutes to answer some questions?
No (if no) I understand, Thank you for your time and have a nice day/night.
Yes (if yes) Thank you. The following questions have been approved by the Office of Management and Budget under number 1660-0036. Please be assured your answers will not affect the outcome of your application for FEMA assistance.
Question 1
Did you know your community had an evacuation plan? Yes/No
If No: Thank you for your time and have a nice day.
If Yes go to 2
2. How did you hear about your community’s evacuation plan?
Newspaper Flyer Church friends/family
TV/Radio Web page Local community outreach Other
3. How helpful was that information?
Extremely Helpful
Very Helpful
Somewhat Helpful
Not Very Helpful
Not at all Helpful
3a. If not helpful, why not?
4. Would you say the timeliness of the information provided was…
Excellent
Good
Satisfactory
Below average
Poor
4a. If below average or poor, what were your reasons?
5. Were you provided information on when and how to return home after the evacuation? Yes/No
If no, skip to 7.
If yes, go to 5a.
5a. How satisfied were you with that information?
Very satisfied
Somewhat satisfied
Satisfied
Somewhat unsatisfied
Very unsatisfied
If unsatisfied, what were your reasons?
6. What could be done to improve the plan to return and when?
7. .How satisfied were you with implementation of the evacuation plan?
Very satisfied
Somewhat satisfied
Satisfied
Somewhat unsatisfied
Very unsatisfied
7a. If unsatisfied, what were your reasons?
Suggestion. FEMA is interested in getting your opinion on what we could do to improve our service. What other suggestions would you like to pass on to FEMA that you haven’t already shared?
Call back: Your opinion is very valuable to us, may we call you at a later date to ask you some additional questions?
Yes (If “yes”) Thank you very much for your time. Have a good day/evening.
No (If “no”) I understand. Thank you very much for your time. Have a good day/evening.
FEMA Form 007-0-13
File Type | application/msword |
File Title | BACKGROUND |
Author | TxNPSC |
Last Modified By | mbilling |
File Modified | 2011-01-20 |
File Created | 2011-01-03 |