Individual Satisfaction Survey
* Required
Is the Direct Care Staff on time?
*
YES
NO
Does the Direct Care Staff follow the Individual Support Plan (ISP)
*
YES
NO
Is the Direct Care Staff respectful to you and your rights?
*
YES
NO
Does the Direct Care Staff work the scheduled amount of hours?
*
YES
NO
Does the Program Coordinator return your calls promptly?
*
YES
NO
Have you had any complaints or concerns not addressed?
*
YES
NO
Are you satisfied with your current Direct Care Staff?
*
YES
NO
Have you had the need to call the office?
*
YES
NO
If yes, when you call the office, is our staff courteous?
*
YES
NO
Do you need services which are not provided?
*
YES
NO
If so, what services?
Your answer
What can we do to improve our services?
Your answer
How would you rate our overall services?
*
Poor
1
2
3
4
5
Great
Direct Care Staff Name
Your answer
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