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  1. Type of Incident or Encounter:*

  2. Please select the response that most accurately reflects your opinion for each statement.

  3. The 911 Dispatcher was polite, helpful, and acted with a sense of urgency. *

  4. The Fire Department arrived in a reasonable amount of time.*

  5. The Fire Department Members presented themselves in a Professional and Respectful manner.*

  6. The Fire Department members addressed all my concerns or needs. *

  7. The Fire Department members ensured I was aware of their actions and informed me of what I should do next.*

  8. The Fire Department members ensured the situation was safe/ complete before leaving.*

  9. Optional Contact Information

  10. Would you like a member of the Fire Department Command Staff to contact you?*

  11. If you answered yes, please provide at least one of the next two.

  12. Leave This Blank:

  13. This field is not part of the form submission.