Input Survey Community

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:

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

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*

Comments

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

Case Management/Job Coach - Case Manager/Job Coach was polite and respectful*

Case Management/Job Coach - My concerns were addressed in a timely manner*

Case Management/Job Coach - Goodwill made accommodations as necessary*

Case Management/Job Coach - 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

Safety - The buildings and facilities were easy to navigate*

Safety - I knew what to do in an emergency*

Safety - I felt safe while at Goodwill*

Comments

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

Training - Presenter was polite and respectful*

Training - I understood the information presented*

Training - The training classes will be or were helpful in getting a job*

Comments