Customer Survey forms

Consumer Durables Consumer Non-durables Service Industry

Note: These forms are only illustrative . The organizations can customize the form
to suit their requirements.
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Customer feedback form - Consumer Durables

Car, T.V, Refrigerator, A.C, Washing machines, Music systems, Computers etc.

Customers should enter their score on 1 to 5 scale ( 1 is the lowest and 5 is the
highest )

Parameter Meeting Requirements 1 2 3 Caters to expectations. Meets all promised /

stated requirements. Meets all implied needs. Quality 4 Product Quality. Product
performance:In normal conditions. In difficult conditions. Product features.
Product durability. Ease in operation. Ease in maintenance. Aesthetics.
Environment friendliness. Price 13 14 15 Value for money. Wide range to suit
individual's budget. Availability of loan under customized schemes.

Score

5 6 7 8 9 10 11 12

Contd…2 Sheet 2
Specimen customer feedback form - Consumer Durables

Parameter

Dealing experience 16 17 18 19 Ease in procurement. Proficiency of dealers.

Conduct of dealers . Meeting delivery schedules. After sales 20 Adequate warranty.
After sales service Timeliness Responsiveness Accessibility Empathy Tangibles Easy
availability of spare parts. Market standing Edge over nearest competitor Price
Features Performance Brand image

21 22 23 24 25 26

27 28 29 30

Total score

0
Contd…3 Sheet 3

Suggestion form
Customer's suggestions for making improvements
1

Contd…4

Sheet 4

Analyze ratings from the customers

Note: This part is only meant for the organizations conducing the survey and
therefore need not be sent to the customers.Once the responses are received, the
organizations must analyze them and take steps for making improvements.
0-60, Poor : The product is out dated 61-90, Average : The product needs immediate
steps for improvement 91-120, Good : The product can still do better 121-150,
Excellent : Keep it up . There is no room for complacency
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Customer feedback form - Consumer non durables

Apparrels, Accessories, Food, stationery, peripherals, soft furnishing etc.
Customers should enter their score on 1 to 5 scale ( 1 is the lowest and 5 is the
highest )

Parameter
Meeting Requirements 1 2 3 Caters to expectations Meets all promised / stated
requirements Meets all implied needs Quality 4 5 6 7 8 Product Quality Product
features Product durability Aesthetics Environment friendliness Price 9 10 Value
for money Wide range to suit individual's budget Accessibility 11 Ease in
procurement Market standing Edge over nearest competitor 12 13 14 15
Price Features Aesthetics

Score

Brand image 0

Contd..2
Sheet 2

Suggestion form Customer's suggestions for making improvements 1

Contd…3
Sheet 3

Analyze ratings from the customers

Note: This part is only meant for the organizations conducing the survey and
therefore need not be sent to the customers.Once the responses are received, the
organizations must analyze them and take steps for making improvements.
0-30, Poor : The product is out dated 31-45, Average : The product needs immediate
steps for improvement 46-60, Good : The product can still do better 61-75,
Excellent : Keep it up . There is no room for complacency
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Customer feedback form - Service organizations

Banks, Insurance, Telephone services, Hotels, Airlines etc.
Customers should enter their score on 1 to 5 scale ( 1 is the lowest and 5 is the
highest )

Parameter Meeting Requirements 1 2 3 Caters to expectations. Meets all promised /

stated requirements. Meets all implied needs. Accessibility & Security 4 5 6 7
Good networking. Ability to reach the customer. Ability to make customers
comfortable Customers feel confident & secure Quality 8 9 10 11 12 13 14 Knowledge
of the front line staff in providing desired information. Ability of the staff to
provide professional advice to customers. Ambience of the organization. Attitude
of the staff providing service. Perceived credibility of the organization.
Empowerment of the dealing staff in handling customer grievances. Ability to
handle all customer complaints in non-confrontational manner. Service 15 16 17 18
19 20 21 22 23 Range of products & services. Ability to provide customized
solutions . Sufficient information regarding each & every aspect of customer
interface. Information regarding documentation required alongwith processing time.
Simplicity of the procedures to be followed. Accurate and timely service delivery.
Availability of value added schemes to the customer besides regular service.
Regularly updating customer with new products & services. Providing timely MIS.

Score

Contd…2
Sheet 2

Specimen customer feedback form - Service organizations

Parameter Responsiveness 24 25 26 Sensitivity to customer's time, cost & effort.

Ability to understand and ease the customer's problem. Going out of the way to
help the customer. Price 27 28 Value for money. Wide range to suit individual's
budget. Market standing 29 30 Edge over nearest competitor. Brand image.

0
Contd…3

Sheet 3
Suggestion form
Customer's suggestions for making improvements 1

Contd…4

Sheet 4
Analyze ratings from the customers

Note: This part is only meant for the organizations conducing the survey and
therefore need not be sent to the customers.Once the responses are received, the
organizations must analyze them and take steps for making improvements.
0-60, Poor : The service is out dated 61-90, Average : The service needs immediate
steps for improvement 91-120, Good : The service can still do better 121-150,
Excellent : Keep it up . There is no room for complacency