Customer Satisfaction Survey Anti Social Behaviour
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41. Please tell us a little bit about you
Why do we ask you to provide this information?
We are committed to continually improve the anti-
social behaviour service we offer, and to provide this
service fairly for all. In order to do this we keep certain
information about our customers on computer and
paper records. We use this information to help us
deliver an effective service, and to ensure our services
meet the needs of all our customers in all the
Customer Satisfaction Survey
communities we serve. All information you provide in
this form will be treated in confidence and in line with
Anti-social Behaviour
the Data Protection Act 1988. Any information you
provide about ethnicity, religious belief, sexuality will
This survey asks you to tell us about how well
be treated as sensitive information and access to that
you think we dealt with your complaint about
information will be restricted to designated officers.
anti-social behaviour.
Your ethnic origin
To help us improve our service in the future,
White
Asian or Asian British
please complete the survey and return it to:
British
Indian
Irish
Pakistani
Other
Bangladeshi
The Housing Management Team
Mixed
Chinese
Westway Housing Association
White/Black Caribbean
Other
Ladbrook Hall, 79 Barlby Road,
Other
White/Black African
London W10 6AZ
White/Asian
Middle Eastern
Other
East European
We will treat all information we receive as
Black or Black British
Other ethnic group
confidential. We will not pass your details to
Caribbean
any third party, or identify you in any way.
Prefer not to state
African
Other
Your age
16-24
35-45
55-59
65-74
About You:
25-34
45-54
60-64
75 +
Your name
Prefer not to state
Your sex
Male
Female
Transgender
Do you consider yourself to have a serious illness
Do you require assistance with completing this
or disability?
form?
The term disability covers both physical and mental
No
impairments that have a substantial and long term (i.e.
has lasted or is expected to last at least 12 months)
Yes
Please tell us what you need and
effect on a person’s ability to carry out normal day to
we will contact you
day activities
Examples of a disability include:
- People with HIV, cancer and multiple sclerosis
- Mental health conditions such as schizophrenia
- Learning disabilities such as Down’s Syndrome
Yes
No
Prefer not to state
What is your religious belief?
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
None
Prefer not to state
Other
Please state:
Your telephone
How would you define your sexual orientation?
number
Gay
Lesbian
Heterosexual
Bisexual
Prefer not to state
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Parent category: Life