End of Placement Feedback Form
How was the Carer in the Placement?
Carers Name
First Name
Last Name
Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
End Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Your Customers Surname
Did carer have good communication with the CCL/Supervisor & Office throughout placement?
Yes
No
If No, Why?
Did you feel the carer did a thorough handover covering everything the replacement carer needed?
Yes
No
If No, Why?
Did you feel the carer left the customers home and carers bedroom clean and tidy?
Yes
No
If No, Why?
Do you feel they would benefit from any further training? If so, what?
Did you feel they had adequate support from your office?
Yes
No
If No, Why?
What is the Carers Strengths?
What is the Carers Difficulties?
Carer Summary:
Overall feedback of the carers work
Would you be happy to use this carer again for this package?
Yes
No
If No, Why?
Would you be happy to use this carer again for another one of your packages?
Yes
No
If No, Why?
Name of Your Office:
Completed By:
First Name
Last Name
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