Emergency Services Feedback Form
This Emergency Services Feedback Form helps local governments and emergency service providers collect valuable citizen feedback after emergency incidents. The form captures essential data including response time perception, professionalism of first responders, communication clarity, and overall satisfaction. With conditional logic that adapts questions based on the type of emergency service used, this template ensures relevant and actionable feedback to improve public safety outcomes.
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export function emergencyServicesFeedback(form: FormTs) {
// Emergency Services Feedback Form
// Demonstrates: RatingScale, StarRating, MatrixQuestion, EmojiRating, Timepicker, RadioButton, SuggestionChips
// ============================================
// HEADER
// ============================================
form.addRow(row => {
row.addTextPanel('header', {
label: 'Emergency Services Feedback',
computedValue: () => 'Help us improve our emergency response. Your feedback matters.',
customStyles: {
backgroundColor: '#dc2626',
color: 'white',
padding: '24px',
borderRadius: '12px',
textAlign: 'center'
}
});
});
// ============================================
// SECTION 1: Incident Details
// ============================================
const incidentSection = form.addSubform('incidentDetails', {
title: 'Incident Information'
});
incidentSection.addRow(row => {
row.addRadioButton('serviceType', {
label: 'Which emergency service did you interact with?',
options: [
{ id: 'police', name: 'Police' },
{ id: 'fire', name: 'Fire Department' },
{ id: 'ambulance', name: 'Ambulance / EMS' },
{ id: 'dispatch', name: '911 Dispatch Only' },
{ id: 'multiple', name: 'Multiple Services' }
],
orientation: 'vertical',
isRequired: true
});
});
incidentSection.addRow(row => {
row.addDatepicker('incidentDate', {
label: 'Date of incident',
maxDate: () => new Date().toISOString(),
isRequired: true
}, '1fr');
row.addTimepicker('incidentTime', {
label: 'Approximate time of call',
isRequired: true
}, '1fr');
});
incidentSection.addRow(row => {
row.addDropdown('incidentType', {
label: 'Type of emergency',
options: () => {
const serviceType = incidentSection.radioButton('serviceType')?.value();
if (serviceType === 'police') {
return [
{ id: 'crime', name: 'Crime in Progress' },
{ id: 'accident', name: 'Traffic Accident' },
{ id: 'domestic', name: 'Domestic Disturbance' },
{ id: 'theft', name: 'Theft / Burglary' },
{ id: 'suspicious', name: 'Suspicious Activity' },
{ id: 'other-police', name: 'Other Police Matter' }
];
} else if (serviceType === 'fire') {
return [
{ id: 'structure-fire', name: 'Structure Fire' },
{ id: 'vehicle-fire', name: 'Vehicle Fire' },
{ id: 'gas-leak', name: 'Gas Leak' },
{ id: 'rescue', name: 'Rescue Operation' },
{ id: 'other-fire', name: 'Other Fire Emergency' }
];
} else if (serviceType === 'ambulance') {
return [
{ id: 'medical', name: 'Medical Emergency' },
{ id: 'injury', name: 'Injury / Trauma' },
{ id: 'cardiac', name: 'Cardiac Emergency' },
{ id: 'breathing', name: 'Breathing Difficulty' },
{ id: 'other-medical', name: 'Other Medical Issue' }
];
} else {
return [
{ id: 'general', name: 'General Emergency' },
{ id: 'information', name: 'Information Request' },
{ id: 'other', name: 'Other' }
];
}
},
placeholder: 'Select type of emergency',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
});
// ============================================
// SECTION 2: Response Time Evaluation
// ============================================
const responseSection = form.addSubform('responseEvaluation', {
title: 'Response Time',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null &&
incidentSection.radioButton('serviceType')?.value() !== 'dispatch'
});
responseSection.addRow(row => {
row.addRatingScale('responseTimeSatisfaction', {
label: 'How satisfied were you with the response time?',
preset: 'satisfaction',
size: 'lg',
alignment: 'center'
});
});
responseSection.addRow(row => {
row.addRadioButton('estimatedArrival', {
label: 'Approximately how long did it take for help to arrive?',
options: [
{ id: 'under5', name: 'Under 5 minutes' },
{ id: '5to10', name: '5-10 minutes' },
{ id: '10to15', name: '10-15 minutes' },
{ id: '15to30', name: '15-30 minutes' },
{ id: 'over30', name: 'Over 30 minutes' }
],
orientation: 'vertical'
});
});
// ============================================
// SECTION 3: Service Quality Matrix
// ============================================
const qualitySection = form.addSubform('serviceQuality', {
title: 'Service Quality Evaluation',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
qualitySection.addRow(row => {
row.addMatrixQuestion('qualityMatrix', {
label: 'Please rate the following aspects of the service you received:',
rows: () => {
const serviceType = incidentSection.radioButton('serviceType')?.value();
const baseRows = [
{ id: 'professionalism', label: 'Professionalism of responders', isRequired: true },
{ id: 'communication', label: 'Clear communication', isRequired: true },
{ id: 'empathy', label: 'Empathy and compassion' }
];
if (serviceType === 'dispatch' || serviceType === 'multiple') {
baseRows.unshift({ id: 'dispatch', label: '911 operator helpfulness', isRequired: true });
}
if (serviceType !== 'dispatch') {
baseRows.push({ id: 'resolution', label: 'Effective resolution of situation' });
}
return baseRows;
},
columns: [
{ id: 'poor', label: 'Poor' },
{ id: 'fair', label: 'Fair' },
{ id: 'good', label: 'Good' },
{ id: 'excellent', label: 'Excellent' }
],
striped: true,
fullWidth: true
});
});
// ============================================
// SECTION 4: Star Ratings for Specific Areas
// ============================================
const ratingsSection = form.addSubform('detailedRatings', {
title: 'Detailed Ratings',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
ratingsSection.addRow(row => {
row.addStarRating('overallRating', {
label: 'Overall experience rating',
maxStars: 5,
size: 'lg',
alignment: 'center',
showConfettiOnMax: true
});
});
ratingsSection.addRow(row => {
row.addStarRating('safetyFeeling', {
label: 'How safe did you feel during the interaction?',
maxStars: 5,
size: 'md',
alignment: 'center'
}, '1fr');
row.addStarRating('informationProvided', {
label: 'Quality of information provided',
maxStars: 5,
size: 'md',
alignment: 'center'
}, '1fr');
});
// ============================================
// SECTION 5: Overall Satisfaction (NPS)
// ============================================
const npsSection = form.addSubform('npsSection', {
title: 'Would You Recommend Our Services?',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null,
customStyles: () => {
const category = npsSection.ratingScale('npsScore')?.npsCategory();
if (category === 'promoter') return { backgroundColor: '#d1fae5', padding: '16px', borderRadius: '8px' };
if (category === 'passive') return { backgroundColor: '#fef3c7', padding: '16px', borderRadius: '8px' };
if (category === 'detractor') return { backgroundColor: '#fee2e2', padding: '16px', borderRadius: '8px' };
return { padding: '16px', borderRadius: '8px', border: '1px dashed #e5e7eb' };
}
});
npsSection.addRow(row => {
row.addRatingScale('npsScore', {
label: 'How likely are you to recommend our emergency services to others?',
preset: 'nps',
showCategoryLabel: true,
showSegmentColors: true,
size: 'md'
});
});
// ============================================
// SECTION 6: Emotional Experience
// ============================================
const emotionSection = form.addSubform('emotionalExperience', {
title: 'Your Experience',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
emotionSection.addRow(row => {
row.addEmojiRating('overallFeeling', {
label: 'How do you feel about the overall experience?',
preset: 'satisfaction',
size: 'lg',
showLabels: true,
alignment: 'center'
});
});
// Positive highlights for satisfied respondents
emotionSection.addRow(row => {
row.addSuggestionChips('positiveAspects', {
label: 'What did we do well? (Select all that apply)',
suggestions: [
{ id: 'fast', name: 'Fast response' },
{ id: 'professional', name: 'Professional conduct' },
{ id: 'caring', name: 'Caring attitude' },
{ id: 'clear', name: 'Clear communication' },
{ id: 'thorough', name: 'Thorough service' },
{ id: 'followup', name: 'Good follow-up' }
],
alignment: 'center',
isVisible: () => {
const feeling = emotionSection.emojiRating('overallFeeling')?.value();
return feeling === 'good' || feeling === 'excellent';
}
});
});
// Areas for improvement for unsatisfied respondents
emotionSection.addSpacer();
emotionSection.addRow(row => {
row.addSuggestionChips('improvementAreas', {
label: 'What could we improve? (Select all that apply)',
suggestions: [
{ id: 'speed', name: 'Response speed' },
{ id: 'communication', name: 'Communication' },
{ id: 'attitude', name: 'Staff attitude' },
{ id: 'equipment', name: 'Equipment/Resources' },
{ id: 'followup', name: 'Follow-up care' },
{ id: 'information', name: 'Information provided' }
],
alignment: 'center',
isVisible: () => {
const feeling = emotionSection.emojiRating('overallFeeling')?.value();
return feeling === 'bad' || feeling === 'very-bad' || feeling === 'neutral';
}
});
});
// ============================================
// SECTION 7: Additional Comments
// ============================================
const commentsSection = form.addSubform('comments', {
title: 'Additional Comments',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
commentsSection.addSpacer();
commentsSection.addRow(row => {
row.addTextarea('additionalFeedback', {
label: () => {
const npsCategory = npsSection.ratingScale('npsScore')?.npsCategory();
if (npsCategory === 'promoter') return 'What made your experience exceptional?';
if (npsCategory === 'detractor') return 'How can we improve our emergency services?';
return 'Please share any additional feedback or suggestions';
},
placeholder: 'Your comments help us serve the community better...',
rows: 4,
autoExpand: true
});
});
// ============================================
// SECTION 8: Contact Information (Optional)
// ============================================
const contactSection = form.addSubform('contactInfo', {
title: 'Follow-up Contact (Optional)',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
contactSection.addRow(row => {
row.addCheckbox('requestCallback', {
label: 'I would like someone to contact me regarding my feedback'
});
});
contactSection.addRow(row => {
row.addTextbox('contactName', {
label: 'Your name',
placeholder: 'Full name',
isVisible: () => contactSection.checkbox('requestCallback')?.value() === true,
isRequired: () => contactSection.checkbox('requestCallback')?.value() === true
}, '1fr');
row.addEmail('contactEmail', {
label: 'Email address',
placeholder: 'your@email.com',
isVisible: () => contactSection.checkbox('requestCallback')?.value() === true,
isRequired: () => contactSection.checkbox('requestCallback')?.value() === true
}, '1fr');
});
// ============================================
// SECTION 9: Summary
// ============================================
const summarySection = form.addSubform('summary', {
title: 'Feedback Summary',
isVisible: () => ratingsSection.starRating('overallRating')?.value() !== null
});
summarySection.addRow(row => {
row.addTextPanel('summaryContent', {
computedValue: () => {
const serviceType = incidentSection.radioButton('serviceType')?.value();
const overallRating = ratingsSection.starRating('overallRating')?.value();
const npsScore = npsSection.ratingScale('npsScore')?.value();
const npsCategory = npsSection.ratingScale('npsScore')?.npsCategory();
const feeling = emotionSection.emojiRating('overallFeeling')?.value();
if (!overallRating) return '';
const serviceLabels: Record<string, string> = {
'police': 'Police',
'fire': 'Fire Department',
'ambulance': 'Ambulance / EMS',
'dispatch': '911 Dispatch',
'multiple': 'Multiple Services'
};
const feelingEmojis: Record<string, string> = {
'very-bad': '😢',
'bad': '😕',
'neutral': '😐',
'good': '😊',
'excellent': '😍'
};
let summary = `Emergency Services Feedback\n`;
summary += `${'═'.repeat(30)}\n\n`;
summary += `Service: ${serviceLabels[serviceType || ''] || 'Not specified'}\n`;
summary += `Overall Rating: ${'★'.repeat(overallRating)}${'☆'.repeat(5 - overallRating)}\n`;
if (npsScore !== null && npsScore !== undefined) {
summary += `Recommendation Score: ${npsScore}/10 (${npsCategory?.charAt(0).toUpperCase()}${npsCategory?.slice(1)})\n`;
}
if (feeling) {
summary += `Experience: ${feelingEmojis[feeling] || ''}\n`;
}
summary += `\nThank you for helping us improve public safety!`;
return summary;
},
customStyles: () => {
const npsCategory = npsSection.ratingScale('npsScore')?.npsCategory();
const baseStyles = {
padding: '16px',
borderRadius: '8px',
whiteSpace: 'pre-wrap',
fontFamily: 'monospace',
fontSize: '14px'
};
if (npsCategory === 'promoter') {
return { ...baseStyles, backgroundColor: '#d1fae5', borderLeft: '4px solid #10b981' };
} else if (npsCategory === 'passive') {
return { ...baseStyles, backgroundColor: '#fef3c7', borderLeft: '4px solid #f59e0b' };
} else if (npsCategory === 'detractor') {
return { ...baseStyles, backgroundColor: '#fee2e2', borderLeft: '4px solid #ef4444' };
}
return { ...baseStyles, backgroundColor: '#f3f4f6', borderLeft: '4px solid #9ca3af' };
}
});
});
// ============================================
// FORM CONFIGURATION
// ============================================
form.configureSubmitButton({
label: 'Submit Feedback',
isVisible: () => incidentSection.radioButton('serviceType')?.value() !== null
});
form.configureCompletionScreen({
type: 'text',
title: 'Thank You for Your Feedback!',
message: 'Your input helps us improve emergency services for our entire community. If you requested a callback, a representative will contact you within 2-3 business days.'
});
}
Frequently Asked Questions
When should emergency services feedback be collected?
Best practice is to collect feedback 24-48 hours after the incident when the experience is fresh but emotions have settled. Avoid immediate post-incident surveys as they may capture distress rather than service quality feedback. For non-emergency calls, feedback can be collected sooner.
How can this form improve emergency response?
Regular feedback collection helps identify training needs, equipment gaps, and communication issues. Track response time perception vs actual times, identify recurring problems in specific areas, and recognize outstanding responders. Data-driven improvements lead to better community safety outcomes.
Is this form anonymous?
The form can be configured for anonymous or identified feedback. For sensitive incidents, anonymous options encourage honest responses. For follow-up cases, contact information allows for service recovery and detailed investigation when needed.
Can I customize this for different emergency services?
Yes, the template adapts based on the type of service (police, fire, EMS, dispatch). You can add department-specific questions, modify rating criteria, and include specialized follow-up sections for different incident types.
How should negative feedback be handled?
Negative feedback should trigger a service recovery process. The form includes options for respondents to request follow-up contact. Systematic analysis of negative patterns helps identify systemic issues requiring policy or training changes.