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web-hack-mirror/mirror/2000/02/15/isweb.tasc.dot.gov/SURVEY.HTM

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<html>
<head>
<title>Survey</title>
</head>
<body>
<form method="POST" name="Survey" action="_vti_bin/shtml.dll/SURVEY.HTM" webbot-action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" U-File="_private/survey.txt" S-Format="TEXT/CSV" S-Label-Fields="TRUE" B-Reverse-Chronology="FALSE" S-Builtin-Fields startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" endspan i-checksum="43374" --><div align="left"><p><strong><big>Publication
Services Customer Survey</big><br>
</strong></p>
</div><p>DOT Requisition No. <input type="text" name="Req_No" size="20">&nbsp;&nbsp;&nbsp;
DOT File No. &nbsp; <input type="text" name="File_No" size="20"></p>
<table border="1" width="640" bordercolor="#FFFFFF">
<tr>
<td width="131%">1. Did you get what you asked for on the request?</td>
<td width="12%"><input type="radio" value="Yes" checked name="R1">Yes </td>
<td width="1%"><input type="radio" name="R1" value="No">No&nbsp; </td>
<td width="2%"><input type="radio" name="R1" value="N/A">N/A</td>
</tr>
<tr>
<td width="131%">2. Was your job delivered on time?</td>
<td width="12%"><input type="radio" name="R2" value="Yes" checked>Yes </td>
<td width="1%"><input type="radio" name="R2" value="No">No&nbsp; </td>
<td width="2%"><input type="radio" name="R2" value="N/A">N/A</td>
</tr>
<tr>
<td width="131%">3. Was the primary person who helped you knowledgeable<br>
about your job requirements?</td>
<td width="12%"><input type="radio" name="R3" value="Yes" checked>Yes&nbsp; </td>
<td width="1%"><input type="radio" name="R3" value="No">No&nbsp; </td>
<td width="2%"><input type="radio" name="R3" value="N/A">N/A</td>
</tr>
<tr>
<td width="131%">4. Were you treated courteously and in a professional manner?</td>
<td width="12%"><input type="radio" name="R4" value="Yes" checked>Yes</td>
<td width="1%"><input type="radio" name="R4" value="No">No</td>
<td width="2%"><input type="radio" name="R4" value="N/A">N/A</td>
</tr>
<tr>
<td width="131%">5. Did the quality of the job meet your expectations?</td>
<td width="12%"><input type="radio" name="R5" value="Yes" checked>Yes</td>
<td width="1%"><input type="radio" name="R5" value="No">No</td>
<td width="2%"><input type="radio" name="R5" value="N/A">N/A</td>
</tr>
<tr>
<td width="131%">6. Will you continue to use our services?</td>
<td width="12%"><input type="radio" name="R6" value="Yes" checked>Yes</td>
<td width="1%"><input type="radio" name="R6" value="No">No</td>
<td width="2%"><input type="radio" name="R6" value="N/A">N/A</td>
</tr>
<tr>
<td width="131%">7. Will you recommend TASC Services to others?</td>
<td width="12%"><input type="radio" name="R7" value="Yes" checked>Yes</td>
<td width="1%"><input type="radio" name="R7" value="No">No</td>
<td width="2%"><input type="radio" name="R7" value="N/A">N/A</td>
</tr>
<tr>
<td width="137%" colspan="4"><div align="right"><p>If not what can we do to improve our
service? <input type="text" name="improve" size="35"></td>
</tr>
<tr>
<td width="112%">8. Would you like to be contacted about your job?</td>
<td width="12%"><input type="radio" name="R8" value="Yes" checked>Yes</td>
<td width="1%"><input type="radio" name="R8" value="No">No</td>
<td width="1%"><input type="radio" name="R8" value="N/A">N/A</td>
</tr>
<tr>
<td width="79%">&nbsp;</td>
<td width="25%">&nbsp;</td>
<td width="15%">&nbsp;</td>
<td width="18%">&nbsp;</td>
</tr>
</table>
<p>What I liked most ~ <input type="text" name="T1" size="55"></p>
<p>What I would recommend ~ <input type="text" name="T2" size="49"></p>
<p>Would you like to recognize an exceptional TASC employee? <input type="text" name="T3" size="24"></p>
<div align="left"><p>General Comments: (optional)<br>
<textarea rows="4" name="S1" cols="71" style="float: none"></textarea></p>
</div><div align="left"><p><strong>Thank you very much for completing this questionnaire.
&nbsp; If you have any questions regarding<br>
this survey, feel free to contact Craig Larsen (202) 366-1264.</strong></p>
</div><table border="1" width="640">
<tr>
<td width="100%" colspan="4" style="background-color: rgb(0,0,0); color: rgb(255,255,255)" bgcolor="#000000" bordercolor="#FFFFFF"><div align="center"><center><p>OPTIONAL
INFORMATION</td>
</tr>
<tr align="center">
<td width="25%" bordercolor="#FFFFFF" align="center">Customer Name:<br>
<input type="text" name="T4" size="20"></td>
<td width="25%" bordercolor="#FFFFFF" align="center">Mode:<br>
<input type="text" name="T5" size="10"></td>
<td width="25%" bordercolor="#FFFFFF" align="center">Telephone:<br>
<input type="text" name="T6" size="11"></td>
<td width="25%" bordercolor="#FFFFFF" align="center">Date:<br>
<input type="text" name="T7" size="13"></td>
</tr>
<tr align="center">
<td width="100%" colspan="4" bordercolor="#FFFFFF"><div align="center"><center><p>Email: <input type="text" name="T8" size="23"></td>
</tr>
</table>
<div align="center"><center><p><input type="submit" value="Submit" name="B1"><input type="reset" value="Reset" name="B2"></p>
</center></div>
</form>
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</body>
</html>