Division Cluste/Section Name of Client

No. Activity Name

First Name Last Name

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Survey Accomplishment Date DOH Name of staff who rendered the
Sex
Employee? service

(mm/dd/yyyy) (M/F) (Y/N) First Name Last Name

 Reliability Reliability Reliability Reliability Responsive

A
How would you
rate your overall B2 B3 B5
B1 B4
expectation of The objectives of Adequate time The content of the The resource The organizers
the was provided for activity was are prompt and
the event were speaker/s is/are
questions and organized and always willing to
training/worksh met knowledgable.
discussions easy to follow. help clients.
op?
 Assurance Empathy Tangible Tangible

B8 C
The appearance
of the
Overall, how
B7 B9 would you rate
physical/virtual
B6 The organizers The quality of the the quality of D. Comments
facility of the
The organizers are sensitive to physical/virtual the
service provider
are polite. the participants’ amenities are
is in keeping with training/worksh
needs. excellent.
the type of op provided?
service/s
provided.
FORM 2.0 PERFORMANCE FREQUENCY COUNTS PER STATEMENT
Total Frequency Counts
Statement 1 2 3 4
A. How would you rate your overall expectation of the
0 0 0 0
training/workshop?

B1. The objectives of the event were met. 0 0 0 0

B2. Adequate time was provided for questions and

0 0 0 0
discussions.
B3. The content of the activity was organized and easy to
0 0 0 0
follow.

B4. The resource speaker/s is/are knowledgeable. 0 0 0 0

B5. The organizers are prompt and always willing to help

0 0 0 0
clients.

B6. The organizers are polite. 0 0 0 0

B7. The organizers are sensitive to the participants’ needs. 0 0 0 0

B8. The appearance of the physical facilities of the service

0 0 0 0
provider is in keeping with the type of service provided.

B9. The quality of the food is excellent. 0 0 0 0

C. Overall, how would you rate the quality of the

0 0 0 0
training/workshop provided?
D. Comments
Verbatim comments as indicated in the form.

PERFORMANCE PER SERVICE FORM

Form 2.0
Total Min Max
Dimensions
Counts (lowest Avg (highest
rate) rate)

Overall Expectation 0 0 #DIV/0! 0

Reliability 0 0 #DIV/0! 0

Responsiveness 0 0 #DIV/0! 0

Assurance 0 0 #DIV/0! 0

Empathy 0 0 #DIV/0! 0

Tangible 0 0 #DIV/0! 0

Overall SERVQUAL Score

Overall Service Quality 0 0 #DIV/0! 0

Total Frequency Counts Total
Average
5 6 7 Blank N/A Clients

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 #DIV/0!

SERVQU
Interpreta
AL
tion
SCORE

#DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0!
 SERVQUAL SCORE OVERALL EXPECTATION OVERALL SERVICE QUALITY

Needs Improvement: Low Expectation: [1,3) Poor: [1, 1.5)

SERVQUAL Score <0 1≥ overall expectation˂3 1 ≥ overall service quality ˂1.5

Exceeds Expectation: Middle Expectation: [3,5) Fair: [1.5, 2.5)

SERVQUAL Score > 0 3 ≥ overall expectation ˂5 1.5 ≥ overall expectation ˂2.5
Interpretation
Meets Expectation: High Expectation:[5,7] Good:[2.5, 3.5)
SERVQUAL Score = 0 5 ≥ overall expectation 2.5 ≥ overall expectation ˂ 3.5

Excellent:[3.5, 4]
3.5 ≥ overall expectation
 DOH Activity? Division
No. Name of Agency/Company

(Y/N)
(Code)
(If Yes or "Y", skip column C)

1
2
3
4
5
6
7
8
9
10
Cluster/Section Name of Client
Activity Name

(Code) First Name Last Name

Survey Accomplishment Sex DOH
Date Employee?
Name of Resource Person

(mm/dd/yyyy) (M/F) (Y/N)

 Reliability Reliability Reliability Reliability Responsive

A
How would you B5
B2 B3
rate your overall B1 B4 The resource
I gained new The resource
expectation of The presentation insight/s relevant person is well-
The resource person is
was clear and on person is well accommodating
the Resource point.
to the objectives versed on the
prepared. to questions and
Person? of the activity. subject matter.
discussions.
 Assurance Assurance Empathy Tangible

C
Overall, how
B7 B8 would you rate
The presentation The resource
B9 D. Comments
B6 The resource the quality of Verbatim comments
was delivered person is
The resource person is well service as indicated in the
professionally sensitive to the form.
person is polite.
and with participants’
dressed and provided by the
appears neat. Resource
confidence. needs.
Person?
FORM 2.0 PERFORMANCE FREQUENCY COUNTS PER STATEMENT
Total Frequency Count
Statement 1 2 3 4
A. How would you rate your overall expectation of the
0 0 0 0
Resource Person?

B1. The presentation was clear and on point. 0 0 0 0

B2. I gained new insight/s relevant to the objectives of the

0 0 0 0
activity.
B3. The resource person is well-versed on the subject
0 0 0 0
matter.

B4. The resource person is well prepared. 0 0 0 0

B5. The resource person is accommodating to questions

0 0 0 0
and discussions.

B6. The resource person is polite. 0 0 0 0

B7. The presentation was delivered professionally and with

0 0 0 0
confidence.
B8. The resource person is sensitive to the participants’
0 0 0 0
needs.

B9. The resource person is well dressed and appears neat. 0 0 0 0

C. Overall, how would you rate the quality of service

0 0 0 0
provided by the Resource Person?
D. Comments
Verbatim comments as indicated in the form.

PERFORMANCE PER SERVICE FORM

Form 2.0
Dimensions Total Counts Min Max
(lowest Avg (highest
rate) rate)

Overall Expectation 0 0 #DIV/0! 0

Reliability 0 0 #DIV/0! 0

Responsiveness 0 0 #DIV/0! 0

Assurance 0 0 #DIV/0! 0

Empathy 0 0 #DIV/0! 0

Tangible 0 0 #DIV/0! 0

Overall SERVQUAL Score

Overall Service Quality 0 0 #DIV/0! 0

Total Frequency Counts Total
Average
5 6 7 Blank N/A Clients

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 0 0 0 #DIV/0!

0 0 0 #DIV/0!

SERVQU
Interpreta
AL
tion
SCORE

#DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0! #DIV/0!

#DIV/0!
 SERVQUAL SCORE OVERALL EXPECTATION OVERALL SERVICE QUALITY

Needs Improvement: Low Expectation: [1,3) Poor: [1, 1.5)

SERVQUAL Score <0 1≥ overall expectation˂3 1 ≥ overall service quality ˂1.5

Exceeds Expectation: Middle Expectation: [3,5) Fair: [1.5, 2.5)

SERVQUAL Score > 0 3 ≥ overall expectation ˂5 1.5 ≥ overall expectation ˂2.5
Interpretation
Meets Expectation: High Expectation:[5,7] Good:[2.5, 3.5)
SERVQUAL Score = 0 5 ≥ overall expectation 2.5 ≥ overall expectation ˂ 3.5

Excellent:[3.5, 4]
3.5 ≥ overall expectation