NDIS Participant Survey Question Title * 1. What are the services you receive from Empowering Connection Group? Please tick all services that you receive. Social Support Personal Care / Daily Living Support Coordination / Psychosocial Recovery Coaching Specialist Support Coordination Group Activities Innovative Community Participation Other support work Question Title * 2. How often do you receive services from Empowering Connection Group? Please tick one answer below. Daily Several times per week Weekly Once per month SIL / STA As Required - Support Coordination / PRC / Specialist Support Coordination / Allied Health Question Title * 3. How happy are you with the support you receive from Empowering Connection Group’s staff members? Please tick one answer below. Not happy at all Somewhat happy Unsure / No Opinion Happy Very happy Question Title * 4. what could we do to improve our support for you? Question Title * 5. Have you been made aware of your Rights and Responsibilities as a participant of Empowering Connection Group (e.g. when you first met with your Case Worker, through the Participant Handbook/Welcome Pack or as part of regular interactions with Empowering Connection Group staff)? Please tick one answer below. Yes No Unsure Question Title * 6. Do you feel that your Rights and Responsibilities are respected by Empowering Connection Group and our staff? Please tick one answer below. Yes No Unsure Question Title * 7. please tell us why (Optional) Question Title * 8. Has information been provided to you in a way that you understand (e.g. has been explained by staff, a written copy, an Easy English copy, in your native language, or by an interpreter)? Yes No Unsure Question Title * 9. Do you know that you can ask for help if English is your second language or you have difficulty with understanding written English (e.g. translators / Easy English / ask staff)? Please tick one answer below. Yes No Unsure Question Title * 10. Do you feel that your Privacy and Confidentiality is respected by Empowering Connection Group and its staff? Yes No Unsure Question Title * 11. Please tell us why (Optional) Question Title * 12. Are you aware that Empowering Connection Group offers Support Coordination Service as well as other services listed in Question 1? Please tick one answer below. Yes No Unsure Question Title * 13. Are you aware that you can raise a concern or complaint with Empowering Connection Group? Please tick one answer below. Yes No Unsure Question Title * 14. Have you raised a concern or complaint with Empowering Connection Group before? Please tick one answer below. Yes No Unsure Question Title * 15. If you have raised a complaint before, were you happy with the outcome? Please tick one answer below. Yes No I have not raised a complaint Question Title * 16. If No, please tell us why: (Optonal) Question Title * 17. Out of 5 with 5 being the best - How do you rate the overall service you receive from Empowering Connection Group? Question Title * 18. Would you recommend Empowering Connection Group’s services to others? Please tick one answer below. Yes No Unsure Question Title * 19. Please tell us why you would or wouldn’t recommend Empowering Connection Group’s services: Question Title * 20. Is there anything else you would like to tell us? Question Title * 21. Would you like a Empowering Connection Group staff member to contact you about this survey? Please tick one answer below. If yes, please provide your details below. Yes No Question Title * 22. OPTIONAL - Participant Details First Name / Last Name Phone Number Email Done
