DEEOIC Outreach Event Survey

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

3

2

Based on my experience at this event, I trust
DEEOIC to fulfill our country’s commitment to
5
4
nuclear workers and their families.
What factors contributed to your trust raƟng? (You may select more than one)
Helpfulness/commitment level of employees
ExpectaƟons/informaƟon provided

Ability to get my needs addressed
Length of Ɵme of event

Strongly
Disagree N/A

1

N/A

Ease of event
Fairness during event

I am saƟsfied with the event today.

5

4

3

2

1

N/A

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

5

4

3

2

1

N/A

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

5

4

3

2

1

N/A

This event was scheduled for a reasonable
amount of Ɵme.

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 today were helpful.

5

4

3

2

1

N/A

How did you hear about this event?
___ Mail

___Email

___DEEOIC Website

___Resource Center Outreach

___Social Media

___Newspaper Ad

___Radio Ad

___Other:________________________

Why did you want to aƩend this event?

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

The OMB control number for this collection is 1225-0093 and expires on 01/31/2027. 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-3510, 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.