Ref : COM-05

Customer Feedback Survey Version : 01

Date of application :

We are pleased to provide you with our Customer Satisfaction Survey and kindly ask you
to complete it with the conviction to find the necessary collaboration in order to
continuously improve your satisfaction with our products and service.

Client : ……………………………………………….
Function(s) of survey respondent: .........................................................................
Grille d’évaluation

Please use the scale from 1 to 10, where 1 is very dissatisfied and 10 is very satisfied.

Very
Dissatisfied Neutral Satisfied Very satisfied
dissatisfied
1 2 3 4 5

Specify NA when you are not concerned.

Feel free to make all the comments you want, in addition to the scores, especially for any
score less than or equal to 5.

A Satisfaction on PRODUCTS NOTE

A01 Satisfaction on all products
A02 Satisfaction with meeting specifications

B Satisfaction with ORDERS (from order taking to delivery) NOTE

Level of understanding of your technical requirements (delivered =
B01
requested)
B02 Confirmation of your order (Speed of response)
B03 Compliance of the physical quantities delivered with the order form
B04 Compliance with delivery deadlines
B05 The clarity of the documents (invoices/BL)
B06 Compliance with your instructions and delivery-specific requirements
B07 The state of preservation of products (level of cleanliness, packaging
protection, etc.)

C Satisfaction with your CONTACTS with the Leader team NOTE

C01 The availability
C02 The friendliness
C03 The quality/reliability of the information provided
C04 Listening (understanding your expectations and needs)
C05 Frequency of visits and contacts with the Leader team

If you have made a claim over the past 12 months….

 Ref : COM-05
Customer Feedback Survey Version : 01
Date of application :

D SATISFACTION WITH CLAIMS PROCESSING NOTE

D01 The solution (processing) provided by Leader
D02 The processing time

Overall Satisfaction

Note
What is your overall confidence level ?

What is your overall satisfaction ? Note

 Positive comments  Negative comments

Thank you for your participation.