Input Survey ABAWD

Client Name*

Program*

Date*

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 5=excellent, 4=above average, 3=good, 2= fair, 1=unsatisfied, 0=does not apply

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 5=excellent, 4=above average, 3=good, 2= fair, 1=unsatisfied, 0=does not apply

Intake Service Plan - Meeting with Case Manager to develop Job Plan

Intake Service Plan - Case Manager was polite and respectful*

Intake Service Plan I understood the information presented*

Intake Service Plan- The paperwork was easy to fill out*

Rate the following areas 5=excellent, 4=above average, 3=good, 2= fair, 1=unsatisfied, 0=does not apply

Case Management (Meeting with your Case Manager)

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 5=excellent, 4=above average, 3=good, 2= fair, 1=unsatisfied, 0=does not apply

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 5=excellent, 4=above average, 3=good, 2= fair, 1=unsatisfied, 0=does not apply

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 5=excellent, 4=above average, 3=good, 2= fair, 1=unsatisfied, 0=does not apply