1.	Date of Service*
	mm/dd/yyyy

2.	Department: Please select one.
	-- None --311Animal ControlAirport -- Peachtree DeKalbBuilding PermitsBusiness LicenseCode ComplianceCommunity DevelopmentEconomic DevelopmentEmployee BenefitsFacilities ManagementFire RescueGeographical Information Systems (GIS)Human ResourcesInformation Technology(IT)Juvenile CourtLand Development InspectionsLou Walker Senior CenterPolice ServicesPropery AppraisalPurchasing and ContractingRecreation, Parks & Cultural AffairsRecorders CourtRoads and DrainageSanitationTransportationWater/Sewer BillingWorkforce DevelopmentVoter Registration and Elections

3.	Please name the employee who provided assistance.

4.	Rate employee’s professionalism while addressing your question or concern.
	Excellent  Good  Neutral  Fair  Poor

5.	Rate employee’s level of courtesy.
	Excellent  Good  Neutral  Fair  Poor

6.	Rate employee’s ability to address your question or concern in a timely manner.*
	Excellent  Good  Neutral  Fair  Poor

7.	Rate employee’s ability to provide clear and concise information.
	Excellent  Good  Neutral  Fair  Poor

8.	Rate your overall experience with the department.
	Excellent  Good  Neutral  Fair  Poor

9.	If you would like to be contacted by this department regarding the service provided, please enter your contact information below.
	Name:   Telephone Number:   Email: