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Qualified Security Assessor Feedback

Qualified Security Assessor (QSA) companies are independent security organizations that have been qualified by the PCI Security Standards Council to validate an entity's adherence to PCI DSS. QSA and Associate QSA (AQSA) Employees are individuals who are employed by a QSA Company, who have satisfied and continue to satisfy all applicable QSA program requirements.

Please use this form to provide feedback about QSAs and AQSAs 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.

QSA Feedback Form

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Form Submitter Name

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Form Submitter To Name

Form Submitter To Email Address

Please provide the following information about the assessor for whom 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:

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Please Explain:

Please answer Y/N to each question below. 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

Qualified Security Assessor Feedback

QSA Feedback Form

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