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2. Home Security Assessment Program Feedback Form

   Thank you for taking the time to complete this form. Your feedback is very important to us and will help us improve this program to better serve Summit residents.

4. Date of appointment
5. Name of officer that completed your assessment
7. Is this the first home security assessment you've had done at your current residence?

   1. Yes
   2. No
8. How well did the experience meet your expectations?

   1. Extremely well
   2. Very well
   3. Somewhat well
   4. Not so well
   5. Not at all well
10. Overall, how satisfied are you with the program?

    1. Very satisfied
    2. Somewhat satisfied
    3. Neither satisfied nor dissatisfied
    4. Somewhat dissatisfied
    5. Very dissatisfied
12. On a scale from 1 to 10, how knowledgeable was the officer on the topic of home security measures?

    1. 10 (Very knowledgeable)
    2. 9
    3. 8
    4. 7
    5. 6
    6. 5
    7. 4
    8. 3
    9. 2
    10. 1 (Not at all knowledgeable)
14. How much more prepared/secure do you feel about your home security measures after this assessment?

    1. 10 (Very prepared)
    2. 9
    3. 8
    4. 7
    5. 6
    6. 5
    7. 4
    8. 3
    9. 2
    10. 1 (Not at all prepared)
16. How satisfied are you with the recommendations for improvement provided by the officer?

    1. Very satisfied
    2. Somewhat satisfied
    3. Neither satisfied nor dissatisfied
    4. Somewhat dissatisfied
    5. Very dissatisfied
18. How likely is it that you would recommend this program to other Summit residents?

    1. 10 (Very likely)
    2. 9
    3. 8
    4. 7
    5. 6
    6. 5
    7. 4
    8. 3
    9. 2
    10. 1 (Not at all likely)
20. Please provide any additional feedback or comments on your experience with the program.
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

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23. Submit

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