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2. Please read the questions below and provide as close to how you feel for each question by selecting an option 0-5.

   0 = I am extremely displeased / disagree completely
   1 = I strong disagree
   2 = I slightly disagree
   3 = I slightly agree
   4 = I strongly agree
   5 = I am extremely impressed / agree completely.

   
   

   This survey is designed to capture and provide feedback for the Porter County Food Service Division. This survey is meant to gather feedback from the manager on duty during the recent Health Department evaluation. We appreciate your time to provide these responses and look forward to receiving your feedback.

4. Professionalism*

   The inspector who performed the evaluation was both professional and courteous.

   1. 0 - I am extremely displeased / disagree completely
   2. 1 - I strongly disagree
   3. 2 - I slightly disagree
   4. 3 - I slightly agree
   5. 4 - I strongly agree
   6. 5 - I am extremely impressed / agree completely
5. You can provide additional details below if you would like.
7. Knowledge*

   The inspector was knowledgeable and helpful.

   1. 0 - I am extremely displeased / disagree completely
   2. 1 - I strongly disagree
   3. 2 - I slightly disagree
   4. 3 - I slightly agree
   5. 4 - I strongly agree
   6. 5 - I am extremely impressed / agree completely
8. You can provide additional details below if you would like.
10. Comprehensiveness*

    The report was easy to read and understand.

    1. 0 - I am extremely displeased / disagree completely
    2. 1 - I strongly disagree
    3. 2 - I slightly disagree
    4. 3 - I slightly agree
    5. 4 - I strongly disagree
    6. 5 - I am extremely impressed / agree completely.
11. You can provide additional details below if you would like.
13. Consistency*

    There has been a consistent message during each inspection for food safety expectations.

    1. 0 - I am extremely displeased / disagree completely
    2. 1 - I strongly disagree
    3. 2 - I slightly disagree
    4. 3 - I slightly agree
    5. 4 - I strongly agree
    6. 5 - I am extremely impressed / agree completely
14. You can provide additional details below if you would like.
16. What did you like best about the visit? (Please provide one example.)*
18. What could the inspector have done better? (Please provide one example.)*
20. Manager On Duty*

    Where you the manager on duty during this inspection?

    1. Yes
    2. No
21. If you wish, please provide any additional feedback you may have regarding your recent evaluation.
23. Name of Inspector*
25. Name of Establishment*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

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