Test Dulu

SURVEI KEPUASAN MASYARAKAT

Rumah Pelayanan Sosial Anak Wira Adhi Karya

Formulir Evaluasi Kualitas Pelayanan Publik

A. Identitas Responden

Pengisian identitas bersifat opsional. Jawablah sesuai pengalaman Anda saat menerima pelayanan.

Tanggal survei Jenis kelamin (opsional) Usia (opsional) Pendidikan terakhir (opsional) Pekerjaan (opsional) Jenis pelayanan yang diterima

B. Penilaian Unsur Pelayanan

Berikan penilaian berdasarkan pengalaman Anda. Pilih satu jawaban untuk setiap unsur.

1 = Tidak Baik · 2 = Kurang Baik · 3 = Baik · 4 = Sangat Baik

C. Saran dan Masukan

Apa saran Anda untuk meningkatkan pelayanan?

Data survei digunakan untuk evaluasi dan peningkatan kualitas pelayanan. Hindari menuliskan NIK, kata sandi, atau informasi pribadi sensitif.

Hasil Penilaian Anda

0,00

Catatan: Hasil ini merupakan estimasi berdasarkan jawaban Anda, bukan rekapitulasi resmi seluruh responden.

Konfirmasi Penutupan

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