Support Intensity Scale (SIS) Survey
Exit this survey
 

Supports Intensity Scale (SIS) Survey

 
PURPOSE: WE WANT TO HEAR FROM ALL PARTICIPANTS IN THE SIS INTERVIEW PROCESS. Please complete and return this questionnaire sharing your reactions to the interview process. Information that you give us will help shape the assessment process in the future.

1. Relationship of person filling out this survey to the individual being served (Select one only)

2. Interview Setting:

3. Did the individual being served participate in the interview?

4. Before the SIS interview, did you:
See a brochure of booklet?

5. Before the SIS interview, did you:
View a DVD?

6. Before the SIS interview, did you:
Attend an orientation session?

7. Did you get other information to help you know what to expect when you went to an interview?

8. Did this information help you know what to expect?

9. Did the interview start on time?

10. Did the interviewer introduce himself/herself?

11. Did the interviewer ask others to introduce themselves?

12. Did the interviewer explain the purpose of the interview?

13. Were the interview questions clear?

14. Did you have enough time to answer all of the interview questions?

15. Did the interviewer cover the areas that are important to you, the individual being served?

16. Were you treated with respect by the interviewer and others?

17. If you are the individual being served and you had help with this form, who helped you?

18. If you are the individual being served and you had help with this form, how did they help you?

19. Please list any additional comments that you have related to any of the above questions or to your experience with the interview process:










Thank you for answering these questions!
If you have any questions and would like to talk to someone about the survey please call Susan Rockwell:

Community Support Network
10 Ferry Street Unit 401
Concord NH 03301
603-229-1982