Quality Assurance Questionnaire - Plainview Volunteer Fire Department

Dear Resident,

The Plainview Fire Department recently responded to your home or office for a medical emergency. In an effort to continually improve our service to the community we would appreciate a few moments of your time to complete the questions below.

If you don’t understand any questions, please use the ‘don’t know’ option and move to the next question. If the question is not relevant to your experience, mark the ‘NA’ box and move on to the next question. Please note that your personal opinions will be kept confidential and that no information, which could identify you, will be released. Information obtained from you will be combined with the other responses and used for analytical purposes only.

Thank you for assisting the Plainfield Volunteer Fire Department in continuing and improving our already great service.

Is the person completing this survey?*
If you are completing the survey on behalf of the patient, where ever possible the questions should be answered from the patient's perspective. However, some questions may relate more to your experience and can be answered from your perspective.
- The patient that was transported
- A relative or care taker of the patient
Your Email*
When calling for an ambulance did you call
- Plainview Fire Department (938-2727)
- 911
- Medical Alert Device
How satisfied were you with the assistance provided by the Fire Department call taker, were you?
Thinking about the time the ambulance took to arrive, were you?
Thinking about how caring the ambulance technicians that attended to you were, were you?
How satisfied were you with the standard of treatment provided by the ambulance technicians, were you?
How satisfied were you with the ambulance technician's explanation about what was happening to you and why, were you?
Thinking about your transport in the ambulance, how satisfied were you with the quality of the ride i.e. smoothness of transport and quietness of the vehicle? Overall, were you?
How satisfied were you overall with your last experience using the Fire Department, were you?
Gender of the Patient
- Male
- Female
- Other
Age of the Patient
Date of Call
MM slash DD slash YYYY
Please add any additional comments you have regarding your experience of the Plainview Volunteer Fire Department.
Call Address
Street Address City State Zip Code
Name
This field is for validation purposes and should be left unchanged.