Input Survey ABAWD

Goodwill of Wayne and Holmes Counties, Inc.
Consumer Name*
Program*
Date*

MonthDayYear
Date
Please help us improve our services by answering the following questions:
Write out any general suggestions you have that would help Goodwill improve our services
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Orientation - Presenter was polite and respectful*
Orientation - I understood the information presented*
Orientation - The paperwork was easy to fill out*
Comments
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Intake - The Case Manager was polite and respectful*
Intake - I understood the information presented*
Intake - The paperwork was easy to fill out*
Comments
Case Management (Meeting with your Case Manager)
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Meeting with your Case Manager - Case Manager was polite and respectful*
Meeting with your Case Manager- My concerns were addressed in a timely manner*
Meeting with your Case Manager - Goodwill made accommodations as necessary*
Meeting with your Case Manager - I knew how to file a complaint*
Comments
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Training and Workshops - Presenter was polite and respectful ( if applicable)*
Training and Workshops - I understood the information presented*
Training and Workshops - The training classes will be or were helpful in getting a job*
Comments
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Safety - I felt safe while at Goodwill and my worksite*
Safety - The buildings and facilities were easy to navigate*
Safety - I knew what to do in an emergency*
Comments
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Work Experience - I learned work skills while at the worksite*
Work Experience - I was treated with respect while at the worksite*
Comments
Rate the following areas 0=does not apply, 1=unsatisfied, 2= fair, 3=good, 4=above average, 5=excellent
Worksite Training - I was adequately trained at the worksite*
Comments
Should be Empty: