4663 Carroll-Cemetery Rd. NW  Carroll, Ohio 43112   740.756.9221


Home Up





 

Contact Us
Phone 740.756.9221

Fax 740.756.9224

 
If you have specific departmental questions, please see their web page by clicking on the department above.

If you have any questions regarding the newsletter, web site, or general questions, please email the Township at . . . . . . . . . . . . . . . . . . . . . . . . . clerk@greenfieldtwp.org or call  740.756.9221. 




 


Emergency Medical Service (ems) Customer Survey

 

 Date of Emergency Medical Service        -- mm/dd/yy

1. Which of the following best describes the type of service you received?

EMS Care without transportation
EMS Care with transportation
Other (If other specify below)

Other Service



2. Did you call 9-1-1?

I made the phone call
Someone called for me

4. How would you rate your overall satisfaction with the 9-1-1 operator?

Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied

5. How long do you feel it took emergency services to arrive at the scene of your emergency?

1-3 Minutes
4-6 Minutes
6-8 Minutes
More than 8 Minutes
Don't Recall

6. Professionalism/Appearance of the emergency medical (EMS) personnel?

Very Satisfied
Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied

7. EMS personnel knowledge/competency in dealing with your emergency?

Very Satisfied
Satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied

8. Do you remember any of the names of the Medical Technicians that came to your aid?


9. Did the Medical Technicians who treated introduce themselves by name and advise you they were with Greenfield Township Fire Department?

By Name and Agency
By Name Only
By Agency Only
Neither
Don't Recall

 

10. Did the medical technicians of Greenfield Township Fire Department ask you what hospital you wanted transported to?

Yes
No
They did but I told them to transport me to nearest hospital
They did but my hospital was on diversion
Don't Recall

Hospital of Choice


Hospital transported to



11. How would you rate your transfer of care from Greenfield Township Fire Department to the Hospital Staff?

Very Satisfied
Satisfied
Neutral
Somewhat dissatisfied
Very Dissatisfied
Don't Recall


12. How satisfied were you with your overall experience with the Medical Technicians?

Very Satisfied
Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
Don't Recall

Comments regarding any questions above, please put question number as well as comment.



Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail

Would you like for someone from Greenfield Township Fire Department to contact you regarding this survey?

Yes
No
Doesn't matter