Congregate Site Survey
Site Name
MLK
Granite Falls
Koinonia
Kings Creek
Name
First Name
Last Name
I. FOOD SERVICE
Very Good
Good
Fair
Poor
Very Poor
The food received is
The food taste is
The food looks is
The menu varies enough from day to day
Yes
No
What are your favorite foods on the menu?
General comments about the food:
II. CONTRIBUTIONS
Is the program contribution box made available to you?
Yes
No
What do you feel is a fair contribution amount?
III. ACTIVITIES
Yes
No
No Response
Are you satisfied with the activities at the site?
Do you receive nutrition education at least once a quarter?
Do you participate in the craft activities at the site?
Do you participate in the exercise program?
What type of activities would you like to see at the site?
What are your favorite activities at the site?
IV. GENERAL
Yes
No
No Response
Do you feel free to make suggestions at the site?
Do you think site rules and policies are reasonable?
Are you satisfied with operating hours?
Please rate the site manager in the following areas:
Very Good
Good
Fair
Poor
Very Poor
Helpful
Fairness
Courtesy
Cleanliness
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