PleaseemailthecompletedreporttoDarcella.Sessomes@doc.nj.gov
NJDOCCOUNTYSERVICES QUALITYASSURANCEQUESTIONNAIRE
Yoursitevisitwasheldon:
Pleaseenterthedateyouarecompletingquestionnaire:
PleaseenteryourFacilityInformation:
Pleaseanswerthefollowingquestionsinordertoprovidethisofficefeedback
1. WhichDOC‐CountyServicesstaffconductedtheinspectionorsitevisit?
a.
b.
2. DidDOCstaffidentifythemselvesuponarrival?
3. WasDOCstaffprofessionalandcourteous?
4. WastheinformationprovidedbyTheOfficeofCountyServices(explanationoftheproblemareas,
observations,etc.)consistentwith10A?
5. Wereissuesofnon‐complianceexplainedinaclearandconcisemanner?
6. Wasthereadebriefingsessionheld?
Pleasefeelfreetoexpandorprovideadditionalcommentsonthesitevisit:
Nameandtitleofthepersoncompletingthereport
WouldyoulikeafollowupcallfromtheAssistantCommissioner?