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Caring Workplace: Client Satisfaction Questionnaire

Thank you for allowing us to serve you. Please know that we are here for you if you continue to have any needs or concerns.

DON'T HESITATE TO CONTACT US: 314-802-6291

As St. Andrew’s is committed to quality care and services, your feedback is vital! Your input will help us to continually evaluate our programs for the working caregiver. If you would take just a few moments to complete this questionnaire, we would be most grateful.

Your Name (Optional)

Date: (xx xx xx)

Name of Company:

.....................................

Please indicate the extent to which you agree or
disagree with each of the following statements, on a
scale of 1-5, where 1 is “Strongly Disagree” and 5 is “Strongly Agree.”

Overall, the Caring Workplace program was helpful to me in caring for my loved one.
 

1 2 3 4 5

The ElderCare specialist who worked with me was knowledgeable about aging issues.
 

1 2 3 4 5

The Caring Workplace increased my awareness of resources available in the community for caregivers.
 

1 2 3 4 5

The Caring Workplace services saved me time and energy.
 

1 2 3 4 5

The Caring Workplace services reduced the amount of on-the-job time spent dealing with caregiving issues.
 

1 2 3 4 5

The Caring Workplace services reduced my stress related to caregiving.
 

1 2 3 4 5

I would refer a coworker to the Caring Workplace program.

 

1 2 3 4 5

I want to see the Caring Workplace program continued at my Company.
 

1 2 3 4 5

My employer has been flexible and supportive regarding my caregiving needs.
 

1 2 3 4 5

.....................................

Please indicate which of the following services of the Caring Workplace you have accessed:

Caregiver Assessment/Care Plan
Support groups
Counseling/emotional support
Referrals to community agencies
Educational seminars/information
Other

Will you give us permission to share your feedback with Human Resources?

Yes
No

.....................................

In what areas could our services be strengthened?

Please feel free to offer any other comments