Department contacted:	Occupational Health & Safety
Name of person contacted Date Your Name (Optional) Your Address (Optional)

1. Your sector is: (Please check appropriately)
	Central Administration Lexington Campus Medical Center Other
2.	How long did it take for us to respond?	same day	next day	more than 2 days
3.	Was your phone call returned within an appropriate amount of time?	Yes	No	Not Applicable
4.	Were you greeted in a courteous manner?	Yes	No	Not Applicable
5.	Was your concern handled with professionalism?	Yes	No	Not Applicable
6.	Was the service provided adequate?	Yes	No	Not Applicable
7.	Did you receive the information you requested?	Yes	No	Not Applicable
8.	If you did not contact the correct department initially, were you directed to the correct department?		Yes	No
9.	Additional Comments:

This form will be sent to dwhibb0@email.uky.edu.