Microsoft PowerPoint - CQI_Measurement

Continuous Quality Improvement

Tool Kit



Sample Satisfaction

Surveys

Page 15

Emergency Services Satisfaction Survey

[Organization] strives to treat all clients with dignity, respect and fairness. We also strive to provide valuable and

quality services to all members of our community. You can help us by letting us know how well we are doing to

achieve these goals. If possible, please take a few moments to complete the survey questions below. Your

responses will remain completely anonymous. Tell us what we need to work on—your responses will be

used to improve the quality of our services. Please answer as honestly as possible. Client satisfaction is

very important to us and we greatly appreciate your feedback in this area.

1. What location did you visit today? [Location A] [Location B]

2. What service(s) did you come in for today?

Clothing Food Housing Assistance

Other (please specify):

For questions 3 - 9, please use the following scale and

mark the appropriate box with your chosen rating. Excellent Good Fair Poor Comments?

3. Please rate the convenience of our hours of service.

______________

4. Please rate us on how clearly our services were

______________

explained during your visit.

5. Please rate the courtesy and friendliness of the staff

______________

member who greeted you when you first came in today

.

6. Please rate the helpfulness of the staff member

______________

who you worked the most with today.

7. Please rate your opinion on the fairness of our staff

______________

(how you feel you were treated in comparison to others).

8. Please rate the timeliness of services received today

______________

(for instance, waiting time and so forth).

9. Please rate the quality of the service you received

______________

(for instance, quality of food or clothing received, etc.).

10. Overall, how satisfied are you with your experience Very Mostly Somewhat Not at all

at [organization] today?

Please use the space below to add other comments about the areas indicated above, or about any other

matters you would like to give us feedback about. (Use the back of this form also if more space is needed):

____________________________________________________________________________________

Thank you again for your time and feedback!

Page 16

Employee Satisfaction Survey

Thank you for giving consideration to and answering the following questions. Upon completion of the form,

please place it in the sealed envelope provided. Completed forms will be delivered by a designated staff

representative to a neutral individual, who will tabulate responses and provide only aggregate data to

[organization] administration. You are welcome to take the Comments page with you and return it in a sealed

envelope to the designated staff representative by noon tomorrow.

Thank you for your cooperation and honest responses.

Rating instructions: Please respond to each of the statements below by using the following 5-point scale:

_____ 1. The expectations of my job are clear to me.

_____ 2. I have access to the tools and materials I need to do my job well.

_____ 3. My job makes good use of my strengths, skills and abilities.

_____ 4. I receive verbal recognition for my work on a regular basis.

_____ 5. I feel that those with whom I work care about me as a person.

_____ 6. I am encouraged by my supervisor/administration to continually further my

professional development.

_____ 7. I feel my thoughts and opinions are valued at work.

_____ 8. I get a feeling of accomplishment, value and purpose from my job.

_____ 9. I observe my co-workers consistently doing high quality work.

_____ 10. I am provided regular opportunities to expand my skills and knowledge.

_____ 11. I am satisfied with the amount of support I receive from supervisors/management.

_____ 12. I believe my working conditions to be safe and healthy.

_____ 13. At [organization] I get a feeling of belonging, that I’m part of a team.

_____ 14. I feel that most of the time the stress level on my job is manageable.

_____ 15. My work contributes to fulfilling the agency’s mission.

_____ 16. My present pay level is fair and adequate as compared to similar organizations.

_____ 17. [Organization]’s current benefit package is fair and adequate as compared to

similar organizations.

_____ 18. [Organization]’s employment/personnel policies are fair and reasonable.

_____ 19. [Organization]’s managers implement employment policies in a fair and consistent

manner.

_____ 20. I am proud to tell friends and acquaintances about where I work.

(Please provide additional comments on attached page)

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Employee Satisfaction Survey – Comments Page

Please feel free to provide any additional comments regarding your responses to the staff satisfaction

survey:

Please provide comments regarding the survey itself, i.e., clarity and phrasing of questions, additional

questions that should be considered to be included, etc.:

Page 18



FoodPantryClientSatisfactionSurvey



Thepurposeofthissurveyistogetabetterunderstandingofhowourclientsfeelaboutthe

[organization]foodpantryservices.Itisourgoaltousetheresultsofthesurveytobetterserve

ourclients.Thesurveyisconfidential.Youranswersarepurelyforthepurposeofimprovingour

services.



Pleaseratethefollowingquestions(1beingthelowestand5beingthehighest).



1. Doyoufeelthatthefoodpantrymeetsallyourfoodneeds?

1 2 3 4 5

LowestHighest



2. Howwouldyouratethenutritionalvalueofthefooditems?

1 2 3 4 5

LowestHighest



3.

Istheamountoffoodenoughforfeedingafamilyfor4days?

 1 2 3 4 5

 LowestHighest



4.Howsatisfiedareyouwiththeoverallfoodpantryservicesyoureceived?

 1 2 3 4 5

 LowestHighest



5.Howsatisfiedareyouwiththefoodpantryhoursofoperation?

 1 2 3 4 5

 LowestHighest



6.Howwouldyouratethehelpfulnessofourstaffinthefoodpantry?

 a.Doesthestaffgivehelpfulsuggestionswhenguidingyouthroughthepantry?

 1 2 3 4 5

 LowestHighest



b.Doesthestaffhelpyoufeelcomfortableasyougothroughthepantry?

 1 2 3 4 5

 LowestHighest



7.Doyouhaveanysuggestionstohelpusmakethefoodpantryservicesmorehelpful?

Page 19

Thank you again for your time and feedback!

Food Services Client Satisfaction Survey

[Organization] strives to treat all clients with dignity, respect and fairness. We also strive to provide valuable and

quality services to all members of our community. You can help us by letting us know how well we are doing to

achieve these goals. If possible, please take a few moments to complete the survey questions below. Your

responses will remain completely anonymous. Tell us what we need to work on—your responses will be

used to improve the quality of our services. Please answer as honestly as possible. Client satisfaction is

very important to us and we greatly appreciate your feedback in this area.

1. How many days a week do you eat at the [location]? _____ (1-5)

2. Please indicate your age group: ___ 18-25 ___ 26-35 ___ 36-45 ___ 46-60 ___ 60 and over

3. Do have children that eat at the [location]? ___ yes ___ no

if yes, what age group are they in? ___ 0-5 ___ 6-10 ___ 11-17

For questions 4 - 10, please use the following scale and

mark the appropriate box with your chosen rating. Excellent Good Fair Poor Comments?

4. Please rate the convenience of our hours of service.

______________

5. Please rate the courtesy and friendliness of the manager.

______________

6. Please rate the courtesy and friendliness of the

______________

volunteers.

7. Please rate the overall atmosphere and feel

______________

of the [location].

8. Please rate the quality of the food.

______________

9. Please rate the quantity of food.

______________

10. Please rate the variety of the food.

______________

11. Overall, how satisfied are you with your experience Very Mostly Somewhat Not at all

at [location] today?

[Organization] is considering moving its Life Skills Program to the [location]. The Life Skills Program is a weekly

educational class that focuses on topics such as budgeting, home ownership, and employment. Dinner and

childcare would still be provided.

12. Would you be interested in attending some of these Very Mostly Somewhat Not at all

classes?

If so, on which evenings could you attend? ____________________________________________

What topics would you like to see covered? ____________________________________________

Please use the space below to add other comments about the areas indicated above, or about any other

matters you would like to give us feedback about. Please indicate other services or information you would like to

see available at [location]. (Use back side also if more space is needed):

____________________________________________________________________________________

Page 20

CLIENT SATISFACTION SURVEY

As part of our continuing effort to improve services we would like to get your thoughts about our

facilities and programs. Your comments are completely anonymous and will be used to inform

ongoing improvements.

General Information

Today’s date: ___________ Program currently enrolled/attending: ____________________________

Please mark only one answer per statement.

1. The building is clean and comfortable.