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NDIS Participant Survey
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
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
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
4.
what could we do to improve our support for you?
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
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
7.
please tell us why (Optional)
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
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
10.
Do you feel that your Privacy and Confidentiality is respected by Empowering Connection Group and its staff?
Yes
No
Unsure
11.
Please tell us why (Optional)
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
13.
Are you aware that you can raise a concern or complaint with Empowering Connection Group? Please tick one answer below.
Yes
No
Unsure
14.
Have you raised a concern or complaint with Empowering Connection Group before? Please tick one answer below.
Yes
No
Unsure
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
16.
If No, please tell us why: (Optonal)
17.
Out of 5 with 5 being the best - How do you rate the overall service you receive from Empowering Connection Group?
1 star
2 stars
3 stars
4 stars
5 stars
18.
Would you recommend Empowering Connection Group’s services to others? Please tick one answer below.
Yes
No
Unsure
19.
Please tell us why you would or wouldn’t recommend Empowering Connection Group’s services:
20.
Is there anything else you would like to tell us?
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
22.
OPTIONAL - Participant Details
First Name / Last Name
Phone Number
Email
