2. Occupant Number*
   Found on the below the business name on the inspection.
4. Name of Inspector*
   -- Select One --Dave Cherrone, Fire MarshalRon Melser Jr., Division ChiefJack Frost, InspectorSean Killelea, InspectorJason Quimby, InspectorPaul Rainwater. Inspector
6. How many years have you been in business in Clay, German, Harris Township or Roseland?
8. How many times has the fire department inspected your facility in the past 5 years?
10. How many hazards were identified at your facility?
12. Pick 1 for each item below.
14. Please rate your satisfaction with the fire safety inspection.*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
16. Please rate the courteousness of the inspector(s).*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
18. How well did the inspector(s) explain why the above items were hazards?*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
20. If you had questions, how well were your questions answered?*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
22. Please rate the professionalism of the inspector(s).*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
24. Please rate the thoroughness of the inspection*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
26. Please rate the knowledge of the inspector(s).*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. No Response
30. Do you have any comments or suggestions for improving our service in the future?
32. Would you like to be contacted about this survey?

    1. Yes
34. First Name (Optional)
35. Last Name (Optional)
37. Phone (Optional)
39. Email (Optional)
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41. 1. Receive an email copy of this form.
42. Email address

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43. Submit

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