Work Program Survey – Valley Residential Services

Day Program/Work Program Survey

Valley Residential Services is committed to providing the best services possible for the people we serve. Thank you in advance for your time!

Home(Required)

Resident Initials(Required)

Please fill in the name of the home and the initials (no full names) of the resident for whom you are completing this survey. If you offer services to multiple residents, please complete a new survey for each resident.

1. Communication from the home(Required)

Please explain why you chose this rating(Required)

2. Home staff are friendly and courteous(Required)

Please explain why you chose this rating(Required)

3. Home staff arrive and depart on time(Required)

Please explain why you chose this rating(Required)

4. Van loading and unloading practices appear safe(Required)

Please explain why you chose this rating(Required)

5. Physical appearance of the residents (neat, clean, appropriately dressed)(Required)

Please explain why you chose this rating(Required)

6. Residents are dressed appropriately for all weather conditions(Required)

Please explain why you chose this rating(Required)

7. Adequate clothing, medications and equipment are available(Required)

Please explain why you chose this rating(Required)

8. Lunches and snacks are prepared in the correct textures(Required)

Please explain why you chose this rating(Required)

9. Additional recommendations/comments:

Optional.

Name of person completing survey

Optional

Contact Information

Optional. If you would like a copy of our Annual Outcomes Management Report, please fill out your name and address in the space provided. The report is an overview of the services we’ve provided and our goals for the future. Thank you.