Customer Satisfaction of Military Community Support Programs Services

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Business Operations Support System

Resource Request Feedback Form

SURGE

Introduction

Welcome to Business Operation Support System (BOSS) Resource Request Feedback Form. You recently requested a Surge resource. A Surge resource supports emerging issues such as military contingencies, natural disasters, crises, and deployment related situations. The types of staff that support Surge requests include Military and Family Life Counselors and Child and Youth Behavioral Counselors. They can provide counseling services for 4 to 90 days.

You have been asked to complete this short form to give feedback on the services provided by the Surge contractor. Your responses will help improve the services we provide to Service members and military families. A summary of the feedback received will be shared with Military Community Support Programs and the vendor quality assurance team. Responses will not be attributed to individuals. This survey is voluntary and takes typically less than five minutes to complete.

1. Rating of the Overall Service Provided by the [Military and Family Life Counselor / Child and Youth Behavioral Counselor]

Domain	Question	Response
Satisfaction		Very satisfied	somewhat satisfied	neither satisfied nor dissatisfied	somewhat dissatisfied	very dissatisfied
	Overall, how satisfied or dissatisfied are you with the service provided by the [Military and Family Life Counselor / Child and Youth Behavioral Counselor]?
Quality		Very high quality	high quality	neither high nor low quality	low quality	very low quality
	How would you rate the quality of the service provided by the [Military and Family Life Counselor / Child and Youth Behavioral Counselor]?
Effectiveness		Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
	How much do you agree or disagree with the following statement? The service provided by the [Military and Family Life Counselor / Child and Youth Behavioral Counselor] met the needs of the military community.
Recommend to a colleague		Highly likely	likely	not sure	unlikely	very unlikely
	How likely is it that you would recommend the Surge resource to a colleague?

2. Rating of the [Military and Family Life Counselor / Child and Youth Behavioral Counselor] Specific Qualities

Please rate the extent to which you agree or disagree with the following statements regarding the specific qualities of the [Military and Family Life Counselor / Child and Youth Behavioral Counselor] during the assignment. Select one response per row.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree	Not Applicable
The [Military and Family Life Counselor / Child and Youth Behavioral Counselor] was available when needed and able to accommodate scheduling demands.
The [Military and Family Life Counselor / Child and Youth Behavioral Counselor] was effective in providing referral and/or resource information.
The [Military and Family Life Counselor / Child and Youth Behavioral Counselor] was effective in delivering program briefings and presentations.
The [Military and Family Life Counselor / Child and Youth Behavioral Counselor] was effective in delivering counseling services.
The [Military and Family Life Counselor / Child and Youth Behavioral Counselor] was knowledgeable of military culture and issues affecting military life.
The [Military and Family Life Counselor / Child and Youth Behavioral Counselor] collaborated well with installation POC and base leadership.

3. In addition to the [Military and Family Life Counselor / Child and Youth Behavioral Counselor], did you interact with a Vendor Point of Contact, such as a Regional Support Coordinator, Regional Supervisor, or Team Lead?

• Yes

• No

• I don’t know

[IF 3 = NO, DON’T KNOW, SKIP TO 5].

4. Vendor Point of Contact Ratings

Please rate the extent to which you agree or disagree with the following statements regarding the specific qualities of the Vendor Point of Contact (POC) (Regional Support Coordinator, Regional Supervisor, or Team Lead) during the assignment. Select one response per row.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree	Not Applicable
The Vendor POC communicated effectively.
The Vendor POC coordinated assignment transitions effectively.
The Vendor POC addressed my needs adequately.
The Vendor POC responded to the needs of the program.

5. Free Text Feedback (Please do not include any personally identifiable information.)

Please tell us anything else we should know about your experience (positive or negative). We appreciate any detail you can provide, especially if our service was less than satisfactory. You will help us to learn and improve. Please be assured that your responses are kept confidential and will not be attributed to individuals.

Closing

Thank you for sharing your feedback. Your responses will help us improve the quality of our programs and services.