Residential Stakeholder Satisfaction Survey

Consumer's Name:

Your Name:

Relationship to Consumer:

You have been identified as a stakeholder for this person, meaning that you have an interest in his or her welfare and a unique perspective regarding the effectiveness of SAVE's services.  Please take a few minutes and answer the questions below.  It will help us to better serve all of our consumers.  Thank you.

Instructions:  Please read each statement and select the number that best reflects your opinion.

              1                    2                    3                      4                    5  
        Strongly            Agree              No                 Disagree        Strongly
         Agree                                    Opinion                                 Disagree

    0 1 2 3 4 5     The home is in good condition?

    0 1 2 3 4 5     My son/daughter/ward is happy in their home?

    0 1 2 3 4 5     My son/daughter/ward gets to do activities in the community?

    0 1 2 3 4 5     If I have a problem, I know who to talk to about the problem?

    0 1 2 3 4 5     I would recommend SAVE to others?

Comments?  Especially those regarding how SAVE can improve services:
   

Thank you for your time spent responding to this survey

Please complete the form above and press the SUBMIT button when finished.

Respite Stakeholder Satisfaction Survey

Consumer's Name:

Your Name:

Relationship to Consumer:

You have been identified as a stakeholder for this person, meaning that you have an interest in his or her welfare and a unique perspective regarding the effectiveness of SAVE's services.  Please take a few minutes and answer the questions below.  It will help us to better serve all of our consumers.  Thank you.

Instructions:  Please read each statement and select the number that best reflects your opinion.

              1                    2                    3                      4                    5  
        Strongly            Agree              Not                Disagree        Strongly
         Agree                                    Certain                                  Disagree

    0 1 2 3 4 5     Did your son/daughter/ward/referral get to do things they indicated they
                   liked during their stay with us?

    0 1 2 3 4 5     If your son/daughter/ward/referral indicated a dislike or fear, did the house
                   manager/ agency make efforts to accommodate this?

    0 1 2 3 4 5     Did you know who to talk to if there were any problems?

    0 1 2 3 4 5     Did your son/daughter/ward/referral enjoy their stay at SAVE?

    0 1 2 3 4 5     Did you get to choose your respite location?

Comments/Suggestions/Services?
   

Thank you for your time spent responding to this survey

Please complete the form above and press the SUBMIT button when finished.