Nebraska Independent Living Center- Individual Satisfaction Survey (Vocational)

Caregiver/Staff

Question Title

* 1. What service(s) is being provided?

Adult Day

Habilitative Workshop

Habilitative Community Inclusion

Behavioral In-Home Habilitation

Medical In-Home Habilitation

Pre-Vocational

Enclave

Supported Employment

Other (please specify)

Question Title

* 2. My caregiver/staff provides positive reinforcement or praise when I complete a task or goal.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 3. I am comfortable with my caregiver/staff and ask for assistance from my caregiver/staff whenever I need help.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree