Qualified PIN Assessor (QPA) Feedback

Please use this form to provide feedback about QPAs and their work product. Information collected from the Feedback Form will be held in strict confidence and used for the sole purpose of improving the quality of service provided by these assessors.

QPA Feedback Form

Fields marked * are required.

Form Submitter Name

Form Submitter Email Address

Form Submitter To Name

Form Submitter To Email Address

Please provide the following information about the assessor that you are providing feedback.

Name of individual assessor *:

Name of assessor company *:

Location of assessment :

Dates of assessment :

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Please provide the following information about you and your company. This information is optional.

Name:

Company Name:

Email Address:

Phone Number:

Entity Type:

Please explain

Please enter Y/N to each question. For all N responses, please provide details to explain.

Question

Response

Comments

1. Did the assessor perform responsibly, diligently, objectively and in the best interest of the customer?

2. Did the assessor respect and safeguard confidential, proprietary, or otherwise sensitive information during the course of professional activities?

3. Did the assessor operate with integrity; honestly and accurately delivering information and guidance and avoiding activities that could constitute a conflict of interest?

4. Additional comments