SLIC - 48Hr Feedback Form
How has the Carer Settled into the Package?
Carers Name
First Name
Last Name
Date
-
Day
-
Month
Year
Date
Time of Call /Visit to Carer
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Did you have communication with the carer before they arrived?
Yes
No
If No, why?
Did you feel the handover covered everything the carer needed to work confidently in this package?
Yes
No
If No, Why?
Do you feel the carer is confident using the Electronic Care Note system?
Yes
No - Full Support Required
Electronic Care Note System Not Used in Customers Home
Do you feel they would benefit from any further training? If so, what?
Do you feel they have adequate support from your office?
Yes
No
If No, Why?
Do they understand who and how to contact relevant people from your Office?
Yes
No
If No, Do they now have this information
Have they had contact from their CCL / Supervisor?
Yes
No
If No, Do they now have this information
Does the carer know how to raise any concerns they may have?
Yes
No
If No, What support has been given to ensure they know who to contact and when?
Do you have any concerns about the carer?
Yes
No
If Yes, What?
Carer Summary:
Customers Surname:
Name of Your Office:
Completed By:
First Name
Last Name
Save
Submit
Should be Empty: