New Hope Industries Provider Satisfaction Survey

First Name (Optional):
Last Name (Optional):
Email Address (Optional):
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Customer Service

 

1. Do the staff provide assistance when you request it?

2. Do the staff assist you in learning new information about the person served? (ie... reinforcers etc.)

 

3. Do the staff provide activities that the person served likes?

 

4. Does the day program/work place have enough work or activities to keep the person served busy?

 

5. Does the day Program/work place have enough staff to help you?

 

6. Does the day program/work place have enough space?

 

Customer Rights

 

 

1. Are the day program/work place staff nice to the person served?

   
2. Do the staff allow the person served to make choices?
   
3. Do the staff listen to the person served?
 
Health and Safety

 

1. Do you feel the day program/work place is safe?

 

2. Does the day program/work place teach the person served what to do in an emergency?

 

3. Is the day program/work place building clean?

 

 
Customer Satisfaction

 

1. Do you like the staff?

 

2. Are you happy with the day program/work place provider?


 

3. Do the staff do a good job at your day program/work place?

Customer Transportation

 

1. Does the person served feel safe when being transported to and from the day program/work site?

 

2. Are the vehicles comfortable?

 

3. Is your driver nice to you?

 

4. Does the person served have a long ride to/from your day program/work place?

 
Additional Comments