mandiri-taspen-kisaran.my.id Open in urlscan Pro
2606:4700:3037::6815:54e7  Public Scan

Submitted URL: https://mandiri-taspen-kisaran.my.id/
Effective URL: https://mandiri-taspen-kisaran.my.id/admin/quisioner_nasabah.php
Submission: On September 11 via api from US — Scanned from CA

Form analysis 1 forms found in the DOM

POST

<form action="" method="post" enctype="multipart/form-data" class="form-horizontal">
  <div class="form-group">
    <label class="control-label col-lg-2">Nama Nasabah</label>
    <div class="col-lg-4">
      <input type="text" name="nama_nasabah" class="form-control" autocomplete="off" required="" data-errormessage-value-missing="nama masih kosong">
    </div>
  </div>
  <div class="form-group">
    <label class="control-label col-lg-2">Usia</label>
    <div class="col-lg-2">
      <input type="text" name="usia" class="form-control" required="" data-errormessage-value-missing="umur masih kosong" maxlength="2" minlength="1" onkeypress="return hanyaAngka(event)">
    </div>
  </div>
  <p class="text-black m-b-30 font-13">
    <font face="Century Gothic" size="2"><strong>Silahkan memberikan survey atas pelayanan yang kami lakukan, dimana hal ini sangat bermanfaat untuk melakukan analisis agar meningkatkan kualitas layanan Kami</strong></font>
    <br>
    <code><span style="font-family: Century Gothic; font-style: italic">
        <font size="2"> Silahkan diisi dengan tanda √ pada □ serta keterangan sesuai dengan penilaian Anda pada kolom yang telah disediakan</font>
      </span></code>
  </p>
  <div class="table-responsive">
    <div id="print">
      <table class="table m-0 table-bordered table-colored-bordered table-bordered-info">
        <tbody>
          <tr>
            <th colspan="3" class="table-colored-full table-full-primary">&nbsp;</th>
            <th colspan="5" class="table-colored-full table-full-danger">
              <center><b><font face="Century Gothic" size="3">Nilai Kinerja</font></b></center>
            </th>
            <th colspan="5" class="table-colored-full table-full-success">
              <center><b><font face="Century Gothic" size="3">Nilai Harapan</font></b></center>
            </th>
          </tr>
          <tr>
            <th>
              <center> No. </center>
            </th>
            <th colspan="2">
              <center>
                <font face="Century Gothic" size="3"> Variabel Pertanyaan</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Sangat Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Cukup Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Kurang Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Tidak Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Sangat Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Cukup Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Kurang Puas</font>
              </center>
            </th>
            <th class="th1">
              <center>
                <font face="Century Gothic" size="2">Tidak Puas</font>
              </center>
            </th>
          </tr>
          <tr>
            <th>
              <font face="Century Gothic" size="2">(1)</font>
            </th>
            <th colspan="2" class="table-colored-full table-full-inverse">
              <font face="Century Gothic" size="2">Empathy (Perhatian)</font>
            </th>
            <td class="table-colored-full table-full-inverse" colspan="10"></td>
          </tr>
          <tr>
            <td> </td>
            <td>1 </td>
            <td>
              <font face="Century Gothic" size="2">Bahasa dan ucapan petugas dalam menerangkan sesuatu mudah dipahami </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila11" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila11" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila11" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila11" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila11" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva11" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva11" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva11" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva11" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva11" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>2 </td>
            <td>
              <font face="Century Gothic" size="2">Mendengarkan kebutuhan dan menerima saran/masukan dari nasabah</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila21" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila21" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila21" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila21" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila21" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva21" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva21" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva21" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva21" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva21" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>3 </td>
            <td>
              <font face="Century Gothic" size="2">Setiap nasabah mendapatkan pelayanan yang memuaskan </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila31" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila31" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila31" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila31" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila31" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva31" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva31" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva31" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva31" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva31" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>4 </td>
            <td>
              <font face="Century Gothic" size="2">Petugas senantiasa sopan dan senyum dalam menyapa nasabah</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila41" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila41" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila41" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila41" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila41" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva41" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva41" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva41" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva41" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva41" value="1" required=""> </td>
          </tr>
          <tr>
            <th>
              <font face="Century Gothic" size="2">(2)</font>
            </th>
            <th colspan="2" class="table-colored-full table-full-inverse">
              <font face="Century Gothic" size="2">Tangibles (Bukti Nyata)</font>
            </th>
            <td class="table-colored-full table-full-inverse" colspan="10"></td>
          </tr>
          <tr>
            <td> </td>
            <td>1 </td>
            <td>
              <font face="Century Gothic" size="2">Bangunan kantor senantiasa terlihat indah dan bersih</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila12" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila12" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila12" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila12" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila12" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva12" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva12" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva12" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva12" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva12" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>2 </td>
            <td>
              <font face="Century Gothic" size="2">Memiliki WC yang selalu bersih</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila22" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila22" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila22" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila22" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila22" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva22" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva22" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva22" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva22" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva22" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>3 </td>
            <td>
              <font face="Century Gothic" size="2">Ketersediaan tempat parkir yang memadai</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila32" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila32" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila32" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila32" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila32" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva32" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva32" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva32" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva32" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva32" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>4 </td>
            <td>
              <font face="Century Gothic" size="2">Ruang tunggu nasabah yang bersih dan nyaman </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila42" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila42" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila42" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila42" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila42" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva42" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva42" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva42" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva42" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva42" value="1" required=""> </td>
          </tr>
          <tr>
            <th>
              <font face="Century Gothic" size="2">(3)</font>
            </th>
            <th colspan="2" class="table-colored-full table-full-inverse">
              <font face="Century Gothic" size="2">Responsive (Ketanggapan)</font>
            </th>
            <td class="table-colored-full table-full-inverse" colspan="10"></td>
          </tr>
          <tr>
            <td> </td>
            <td>1 </td>
            <td>
              <font face="Century Gothic" size="2">Karyawan bersedia membantu nasabah jika dibutuhkan </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila13" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila13" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila13" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila13" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila13" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva13" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva13" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva13" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva13" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva13" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>2 </td>
            <td>
              <font face="Century Gothic" size="2">Karyawan cepat merespon ketika dipanggil</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila23" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila23" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila23" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila23" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila23" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva23" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva23" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva23" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva23" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva23" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>3 </td>
            <td>
              <font face="Century Gothic" size="2">Pelayanan diberikan dalam waktu yang cepat</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila33" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila33" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila33" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila33" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila33" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva33" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva33" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva33" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva33" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva33" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>4 </td>
            <td>
              <font face="Century Gothic" size="2">Mudah dalam kepengurusan administrasi</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila43" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila43" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila43" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila43" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila43" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva43" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva43" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva43" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva43" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva43" value="1" required=""> </td>
          </tr>
          <tr>
            <th>
              <font face="Century Gothic" size="2">(4)</font>
            </th>
            <th colspan="2" class="table-colored-full table-full-inverse">
              <font face="Century Gothic" size="2">Reliability (Kehandalan)</font>
            </th>
            <td class="table-colored-full table-full-inverse" colspan="10"></td>
          </tr>
          <tr>
            <td> </td>
            <td>1 </td>
            <td>
              <font face="Century Gothic" size="2">Kantor buka sesuai jadwal dan tepat waktu</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila14" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila14" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila14" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila14" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila14" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva14" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva14" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva14" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva14" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva14" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>2 </td>
            <td>
              <font face="Century Gothic" size="2">Prosedur pendaftarannya mudah dan tidak berbelit-belit</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila24" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila24" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila24" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila24" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila24" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva24" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva24" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva24" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva24" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva24" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>3 </td>
            <td>
              <font face="Century Gothic" size="2">Service teknisi menggunakan teknologi modern dan canggih </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila34" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila34" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila34" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila34" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila34" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva34" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva34" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva34" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva34" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva34" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>4 </td>
            <td>
              <font face="Century Gothic" size="2">Keakuratan/ketepatan informasi yang diberikan kepada pelanggan </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila44" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila44" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila44" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila44" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila44" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva44" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva44" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva44" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva44" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva44" value="1" required=""> </td>
          </tr>
          <tr>
            <th>
              <font face="Century Gothic" size="2">(5)</font>
            </th>
            <th colspan="2" class="table-colored-full table-full-inverse">
              <font face="Century Gothic" size="2">Assurance (Jaminan)</font>
            </th>
            <td class="table-colored-full table-full-inverse" colspan="10"></td>
          </tr>
          <tr>
            <td> </td>
            <td>1 </td>
            <td>
              <font face="Century Gothic" size="2">Jaminan kelancaran pelayanan ke pelanggan </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila15" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila15" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila15" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila15" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila15" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva15" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva15" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva15" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva15" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva15" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>2 </td>
            <td>
              <font face="Century Gothic" size="2">Tarif administrasi yang terjangkau </font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila25" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila25" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila25" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila25" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila25" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva25" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva25" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva25" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva25" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva25" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>3 </td>
            <td>
              <font face="Century Gothic" size="2">Layanan Call Center 24 Jam</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila35" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila35" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila35" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila35" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila35" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva35" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva35" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva35" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva35" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva35" value="1" required=""> </td>
          </tr>
          <tr>
            <td> </td>
            <td>4 </td>
            <td>
              <font face="Century Gothic" size="2">Keramahan/Kesopanan Pelayanan Karyawan dan Pegawai</font>
            </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila45" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila45" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila45" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila45" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-danger"> <input type="radio" name="aqila45" value="1" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva45" value="5" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva45" value="4" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva45" value="3" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva45" value="2" required=""> </td>
            <td align="center" class="table-colored-full table-full-success"> <input type="radio" name="adiva45" value="1" required=""> </td>
          </tr>
        </tbody>
      </table>
    </div>
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 1. Survey Kepuasan Nasabah
 2. Cetak

Nama Nasabah

Usia


Silahkan memberikan survey atas pelayanan yang kami lakukan, dimana hal ini
sangat bermanfaat untuk melakukan analisis agar meningkatkan kualitas layanan
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Anda pada kolom yang telah disediakan

  Nilai Kinerja Nilai Harapan No. Variabel Pertanyaan Sangat Puas Puas Cukup
Puas Kurang Puas Tidak Puas Sangat Puas Puas Cukup Puas Kurang Puas Tidak Puas
(1) Empathy (Perhatian) 1 Bahasa dan ucapan petugas dalam menerangkan sesuatu
mudah dipahami 2 Mendengarkan kebutuhan dan menerima saran/masukan dari nasabah
3 Setiap nasabah mendapatkan pelayanan yang memuaskan 4 Petugas senantiasa sopan
dan senyum dalam menyapa nasabah (2) Tangibles (Bukti Nyata) 1 Bangunan kantor
senantiasa terlihat indah dan bersih 2 Memiliki WC yang selalu bersih 3
Ketersediaan tempat parkir yang memadai 4 Ruang tunggu nasabah yang bersih dan
nyaman (3) Responsive (Ketanggapan) 1 Karyawan bersedia membantu nasabah jika
dibutuhkan 2 Karyawan cepat merespon ketika dipanggil 3 Pelayanan diberikan
dalam waktu yang cepat 4 Mudah dalam kepengurusan administrasi (4) Reliability
(Kehandalan) 1 Kantor buka sesuai jadwal dan tepat waktu 2 Prosedur
pendaftarannya mudah dan tidak berbelit-belit 3 Service teknisi menggunakan
teknologi modern dan canggih 4 Keakuratan/ketepatan informasi yang diberikan
kepada pelanggan (5) Assurance (Jaminan) 1 Jaminan kelancaran pelayanan ke
pelanggan 2 Tarif administrasi yang terjangkau 3 Layanan Call Center 24 Jam 4
Keramahan/Kesopanan Pelayanan Karyawan dan Pegawai


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