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'Allotment waiting list data'.
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FREEDOM OF INFORMATION ACT 2000
CUSTOMER SATISFACTION SURVEY
(All information given here is confidential and anonymous, completion is voluntary)
1. Date of contact:
2. How satisfied are you with the service you received?
Very satisfied.
Fairly satisfied.
Neither satisfied nor dissatisfied.
Very dissatisfied.
Don't know.
3. Ethnicity
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Tick |
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Tick |
White |
British |
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Mixed |
White & Black Caribbean |
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Irish |
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White & Black African |
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Gypsy Traveller / Roma |
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White & Asian |
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Irish Traveller |
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Other mixed background: (Please state)
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Polish |
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Lithuanian |
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Other white background: (Please state) |
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Black or Black British |
Caribbean |
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African |
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Other Black background: (Please state)
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Asian or Asian British |
Indian |
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Chinese or other Ethnic Groups |
Chinese |
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Pakistani |
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Philippine |
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Bangladeshi |
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Other: (Please state) |
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Other Asian background: (Please state)
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Undeclared |
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4. Disability 5. Gender
Male |
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Female |
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Transgender |
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Undeclared |
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None |
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Registered Disabled under DDA definition |
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Disabled under DDA definition but not registered |
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Long term limiting condition that affects health |
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Long term limiting condition that does not affect health |
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Undeclared |
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6. Age 7. Sexuality 8. Religion / Belief:
0-15 |
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16-24 |
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25-34 |
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35-44 |
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45-59 |
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60-74 |
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75+ |
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Undeclared |
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Heterosexual |
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Gay |
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Lesbian |
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Bi-Sexual |
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Undeclared |
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Buddhist |
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Christian |
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Hindu |
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Jewish |
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Muslim |
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Sikh |
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None Religious |
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Other: (Please state)
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Undeclared |
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Thank you for completing this survey.
Please return to [email address] or Information Officer, Policy and Performance Team, 1st Floor, Civic Centre, Rickergate, Carlisle, Cumbria, CA3 8QG