Employment Client Satisfaction

To complete the form below, all questions must be answered, except as noted.

Client Information

Case Manager Information

Community Skills Trainer Information

1. What are your goals that you are currently working on?

2. Does your Job Coach/Community Skills Trainer assist you in meeting your goals/objectives?

3. Do you feel that you have made progress in your goals?

4. Does your Job Coach/Community Skills Trainer listen to your work related concerns?

5. Do you feel the LTC staff provides you with the support you need?

6. Do you feel that you have been informed of the choices you can make?

7. Do you feel that you are an active participant in the development of your plan?

8. Do you feel that you are treated well and with respect?

9. Can you find your Job Coach when you need him/her?

10. Do you feel that you are a part of the company?

11. Do you feel that you are prepared to become/stay successfully employed?

12. Are you happy with your current job?

13. What part of your job do you like?

14. What part of your job do you not like?

15. Is there another type of job that you are interested in?

16. Do you think it is a safe and clean environment where you work?

17. Would you recommend this service to a friend?

18. What can we improve to serve you better?

19. Any additional concerns/comments?

To The Interviewer

A. Do you think the client understood the questions asked?
B. Is the client?

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