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2. Warning!
   Please do not use this form to report issues of an emergency nature or for conditions requiring an immediate response. If your issue is an emergency, please use the telephone and dial 911.
4. How Was Your Service? Customer Survey
   The Township of Rockaway strives for customer satisfaction and by letting us know how we are doing helps us reach that goal. Please complete the survey and submit it. We appreciate your time and comments.
6. Contact Information
8. First Name
9. Last Name
11. Business Name
13. Email Address*
15. Phone Number
16. Fax Number
18. Address
20. City
21. State
22. Zip Code
24. What date did you visit us?
    What date did you visit us?
26. Was someone ready to help you within a reasonable timeframe?

    1. Yes
    2. No
28. Did the employee actively listen to your request, without interrupting?

    1. Yes
    2. No
30. Did the employee have the knowledge to solve your issue?

    1. Yes
    2. No
32. Did the employee ensure all of your issues were resolved?

    1. Yes
    2. No
34. Did he/she provide you with additional information or options (beyond what was asked)?

    1. Yes
    2. No
36. Was your issue handled professionally?

    1. Yes
    2. No
38. What department did you visit?
    -- Select One --AdministrationClerk'sConstructionCourtDepartment of Public WorksEngineeringFireHealthPlanningPoliceTax AssessorTax CollectorUtilities (water, sewer)Zoning
40. Please provide the name of the employee you spoke to.
42. Did the employee show interest / concern for you?

    1. Yes
    2. No
44. Was the employee upbeat and friendly?

    1. Yes
    2. No
46. Did the employee use positive statements (e.g. What can I do for you)?

    1. Yes
    2. No
48. Was your request handled within an effective timeframe?

    1. Yes
    2. No
50. Please explain why you visited today?
52. Notes:
    If you send us a message, you'll receive a Tracking Number allowing you to follow-up with your request, at your convenience.
54. Privacy Policy
    Privacy Policy

    Information we receive may be considered public information which is subject to disclosure under current state law. Learn more about our Privacy Policy.
56. Thank you for taking the time to fill out our customer survey.
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field