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2. Disclaimer:
   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
6. Tell Us How We're Doing
   To provide feedback on your experience with the Transportation and Engineering division, please fill out this form.
8. Date of Your Last T&E Transaction
   Date of Your Last T&E Transaction
10. What was the primary reason (need) for contact with Transportation & Engineering?*
    -- Select One --ConstructionDesignDevelopment InspectionDrainage / Storm WaterRight-of-WayRight-of-Way PermitsTraffic ConcernTraffic SafetyTransportation StudiesStudies
12. Name of Project, Concern or Study
14. Name of the person who helped you.
18. Please rate the following aspect of service provided by Jefferson County Employees at Transportation and Engineering:
20. Timeliness of Response

    1. Poor
    2. Fair
    3. Good
    4. Very Good
    5. Excellent
21. Courtesy

    1. Poor
    2. Fair
    3. Good
    4. Very Good
    5. Excellent
23. Competency In Handling an Issue

    1. Poor
    2. Fair
    3. Good
    4. Very Good
    5. Excellent
24. Professionalism

    1. Poor
    2. Fair
    3. Good
    4. Very Good
    5. Excellent
26. Timeliness in Resolving Problem / Addressing Need

    1. Poor
    2. Fair
    3. Good
    4. Very Good
    5. Excellent
30. Please evaluate the following statements.
32. How satisfied are you that Transportation & Engineering adequately answered your question or resolved your issue?

    1. Dissatisfied

    1. Somewhat Dissatisfied

    1. Somewhat Satisfied

    1. Satisfied
34. How satisfied are you in the overall job Jefferson County (not just this division) does in providing service?

    1. Dissatisfied

    1. Somewhat Dissatisfied

    1. Somewhat Satisfied

    1. Satisfied
36. What is your prefered method of communication with Transportation and Engineering? *

    1. Person
    2. Phone
    3. Email
    4. Mail
    5. No Contact
38. Communication Comments
40. What would you like to see Transportation and Engineering do better?
44. Optional Information
46. First Name*
47. Last Name*
49. Company
50. Phone Number
52. Email*
54. Would you like to be contacted about your comments?*

    1. Yes

    1. No
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field