Interactive Customer Evaluation
 
OMB 0704-0420, expires 31 OCT 2017
RCS DD-DA&M(AR)2124, expires 31 OCT 2017

SHARP Comment Card

SHARP
Comment Card

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WARNING: Please do not file any RESTRICTED or UNRESTRICTED Reports and personal identifying information on this page. If you have a report you need to file, please contact the DoD Safe Helpline at 877-995-5247, the Fort Sill SHARP hotline at 580-91-SHARP, or come to the SHARP Resource Center at building 2870 Craig Road.

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Were you satisfied with your overall experience?

  
  
  

Do you feel you were treated with respect and dignity by SHARP personnel?

  
  
  
  
  
  

Do you feel your SHARP complaint was taken seriously by your chain of command?

  
  
  
  
  
  

Do you feel all your questions were answered by the SHARP RC Staff?

  
  
  

Did you know how to contact your SARC/VA prior to your complaint?

  
  
  

Was the victim advocate (VA) helpful?

  
  
  
  
  
  

Was the amount of contact you received from your VA adequate?

  
  
  
  
  
  

Was the Special Victim Counselor (SVC) helpful through your process?

  
  
  
  
  
  

Was Criminal Investigation Division (CID) helpful through your process?

  
  
  
  
  
  

Was the Sexual Assault Care Coordinator (SACC) helpful through your process?

  
  
  
  
  
  

Was the Sexual Assault Nurse Examiner (SANE) helpful through your process?

  
  
  
  
  
  

Who was the first person you contacted after your harassment or assault?

If you are a Sexual Assault survivor which reporting option did you choose?

  
  
  

If you are a Sexual Harassment complainant which option did you choose?

  
  
  

If utilized was the SHARP RC clean and welcoming?

  
  
  
  
  
  

Did the SHARP RC meet your needs?

  
  
  

If the SHARP Resource Center was utilized, were you satisfied with your experience at the center?

  
  
  
  
  
  

Would you use the SHARP Resource Center again?

  
  
  

Would you recommend the SHARP RC to others?

  
  
  

Do you feel the SHARP RC being away from your unit is helpful?

  
  
  

Did you recieve victim advocacy at the SHARP RC?

  
  
  

Did you meet with the SVC at the SHARP RC?

  
  
  

Did you receive behavioral health case managment at the SHARP RC?

  
  
  

Did you receive general information from the SHARP RC?

  
  
  

Did you make file a report or complaint and if so which?

What was most useful?

What can we improve?

Other comments (optional):

Facility Appearance

  
  
  
  
  
  

Employee/Staff Attitude

  
  
  
  
  
  

Timeliness of Service

  
  
  
  
  
  

Hours of Service

  
  
  
  
  
  

Did the product or service meet your needs?

  
  
  

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Privacy Advisory: Unless you provide your name, phone, email address or otherwise identify yourself in the text comments on the comment card, all submitted information and comments will remain anonymous. No attempt to identify you or your organization will be made unless the comment card submission or set of submissions reflects a credible or potential threat, or reflects a misuse or abuse of the system, or is related to a law enforcement investigation. If you have a complaint and do not provide a phone number or email address, there will be no way of following up with you directly regarding the complaint. However, all comments and complaints will be examined whether or not you supply contact information. Your comment card submission, including the text comments, may be reviewed by multiple people associated to the service provided. This may, in some cases, include higher levels in the service provider's chain of command. By providing comment information in the text comment box, you are acknowledging that the information provided may be reviewed throughout the organization to which the comment was submitted, and, possibly at higher organization levels within the ICE system.



 





"Thank you for taking the time to complete this comment card. Your opinions are very important to us."