OWCP DEEOIC Outreach Event Feedback Form

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION (DEEOIC)
OFFICE OF WORKERS’ COMPENSATION PROGRAMS
UNITED STATES DEPARTMENT OF LABOR

Outreach Event Feedback Form
Please indicate your answers to the
statements below by circling a response.

Strongly
Agree

Agree

Neutral

Disagree

I am satisfied with the event today.

5

4

3

2

1

n/a

This event increased my trust in DEEOIC.

5

4

3

2

1

n/a

I was able to get my questions answered
during this event.

5

4

3

2

1

n/a

It was easy to understand the information
presented during this event.

5

4

3

2

1

n/a

This event was scheduled for a
reasonable amount of time.

5

4

3

2

1

n/a

I was treated fairly during this event.

5

4

3

2

1

n/a

Employees I interacted with during this
event were helpful.

5

4

3

2

1

n/a

How did you hear about this event?
___ Mail

___Email

___Social Media

Strongly
Disagree N/A

Why did you want to attend this event today?

___DEEOIC Website
___Newspaper Ad

___Resource Center Outreach
___Other:_______________________________

Please describe the most valuable and least valuable parts of today’s event.
(continue on the back of this form if necessary)

The OMB control number for this collection is 1225-0093 and expires on 02/29/2024. According to the Paperwork Reduction Act of 1995, no person is
required to respond to a collection of information unless such collection displays a valid OMB control number. The obligation to respond to this collection is
voluntary. We estimate it takes about 5 minutes to complete this collection of information, including time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing the collection of information. Please send comments regarding the burden estimate or any
other aspect of this collection of information to the U.S. Department of Labor, DEEOIC, 200 Constitution Ave., NW, Room C-3321, Washington, D.C. 20210
and reference OMB Control Number 1225-0093.
OMB Control Number: 1225-0093
Note: Please do not return the completed form to this address.