2. 
6. Please take a moment to complete the survey below
8. Date of Inspection/ Installation
   Date of Inspection/ Installation
10. Was CPS Technician that assisted you professional?

    1. Yes
    2. Neutral
    3. No
12. Was CPS Technician knowledgeable?

    1. Yes
    2. Neutral
    3. No
14. Were you given the opportunity to practice installing the Child Safety Seat(s)?

    1. Yes
    2. Neutral
    3. No
16. After instruction and hands on demonstration, how likely do you feel that you can reinstall the Child Safety Seat(s) correctly?

    1. Extremely likely
    2. Very likely
    3. Likely
    4. Unlikely
    5. Extremely unlikely
18. Did CPS Technician discuss any of the following?

    please check all that apply

    1. Airbags
    2. Unused seatbelts
    3. Projectiles
    4. Unattended children In and around cars
    5. Next steps (e.g. when to graduate to the next child safety seat)
20. Was CPS Technician able to answer any questions that you had?

    1. Yes
    2. No
    3. N/A
22. Please rate your overall satisfaction with your appointment.

    1. Excellent
    2. Good
    3. Fair
    4. Poor
    5. Very poor
24. Comments
26. Thank you from your FDMJ CPS Team
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29. Email address

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