Official PCI Security Standards Council Site - Verify PCI Compliance, Download Data Security and Credit Card Security Standards

Payment Application Qualified Security Assessor Feedback

Payment Application Qualified Security Assessor (PA-QSA) Companies are organizations that have been qualified by the PCI Security Standards Council to perform PA-DSS Assessments for PA-DSS Program purposes. PA-QSA Employees are individuals who are employed by a PA-QSA Company and have satisfied all PA-QSA Requirements applicable to employees of PA-QSA Companies who will conduct PA-DSS Assessments, as described in further detail in the PA-QSA Requirements.

Please use this form to provide feedback about PA-QSAs 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.

PA-QSA Feedback Form

Form Submitter Name

Form Submitter Email Address

Form Submitter To Name

Form Submitter To Email Address

Fields marked * are required.

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

Name of individual assessor *:

Name of assessor company *:

Dates of assessment :

From / /

To / /

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 answer Y/N to each question. For all N responses, please provide an explanation in the box provided.

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

Payment Application Qualified Security Assessor Feedback

PA-QSA Feedback Form

Copyright © 2006 – 2022 PCI Security Standards Council, LLC. All rights reserved. Terms and Conditions.