Date of Incident:  (mm/dd/yyyy)    Type of Incident:

Deputy's Name:    Incident / Report Number 

1.  Was the deputy professional? Yes  No  Comments:

2.  Were you treated with respect? Yes  No  Comments:

3.  Were you treated fairly? Yes  No  Comments:

4.  Do you feel the situation was handled properly?  Yes  No  Comments:

5.  Understanding that this may have been a difficult situation, were you generally satisfied with the Jefferson County Sheriff's Office?                                  Yes  No    Comments:

6.  Was the deputy's response time:  Good  Fair  Poor  N/A Comments:

7.  Was the deputy's demeanor: Good Fair Poor  Comments:

8.  Was the deputy's ability to handle the circumstance: Good  Fair  Poor  Comments:

9.  Your reaction:   Satisfied   Dissatisfied  Comments:

10. As a citizen of Jefferson County, what is your greatest safety or security concern?    Comments:

11.  Do you have any recommendations or suggestions for improvements for the Jefferson County Sheriff's Office?                                                                    If so What: 

12.  If dissatisfied, do you wish for a member of Sheriff's Command Staff to contact you in regards to this incident? Yes No  N/A

 Please provide your contact information: Name: Phone Number:                Address:     

13.  Other Comments: