STRIVE CENTRE MEMBER SATISFACTION SURVEY

This survey is for persons who is a member of the Headway and Strive Centres or participates in the Community Leisure Program (CLP).

We would like to know how well we are doing in supporting you. This survey is confidential, so nobody will know your answers. Everybody’s answers will be collected and combined into one report. Your answers will assist us to target areas for improvement in the program.

You can fill out this survey on your own, or you may ask for help. You may want to ask a friend, family member, caregiver or staff person to help you.

When you have completed your survey please press DONE.

Question Title

* What centre are you a member with:

Headway New Westminster

Headway Vancouver

Community Leisure Program (CLP)

Strive Centre Vancouver

Strive Centre Powell River

Question Title

* General Feedback

1. Why do you participate in this program?

2. What would you change about this program? Are there any barriers?

3. Can you give 3 suggestions of activities you would like to see offered?

4. What do you like most about this program?

Question Title

* Programs

	Yes	Sometimes	No	N/A
5. Are you satisfied with programs and activities offered here?	5. Are you satisfied with programs and activities offered here? Yes	5. Are you satisfied with programs and activities offered here? Sometimes	5. Are you satisfied with programs and activities offered here? No	5. Are you satisfied with programs and activities offered here? N/A
6. Do you have enough to do here?	6. Do you have enough to do here? Yes	6. Do you have enough to do here? Sometimes	6. Do you have enough to do here? No	6. Do you have enough to do here? N/A
7. If you participate in the volunteer departments are you satisfied with the program?	7. If you participate in the volunteer departments are you satisfied with the program? Yes	7. If you participate in the volunteer departments are you satisfied with the program? Sometimes	7. If you participate in the volunteer departments are you satisfied with the program? No	7. If you participate in the volunteer departments are you satisfied with the program? N/A
8. Are you informed of the activities offered here? E.g. monthly schedules, calendars	8. Are you informed of the activities offered here? E.g. monthly schedules, calendars Yes	8. Are you informed of the activities offered here? E.g. monthly schedules, calendars Sometimes	8. Are you informed of the activities offered here? E.g. monthly schedules, calendars No	8. Are you informed of the activities offered here? E.g. monthly schedules, calendars N/A
9. Have you developed friendships/ relationships since joining this program?	9. Have you developed friendships/ relationships since joining this program? Yes	9. Have you developed friendships/ relationships since joining this program? Sometimes	9. Have you developed friendships/ relationships since joining this program? No	9. Have you developed friendships/ relationships since joining this program? N/A

Question Title

* Goals

	Yes	Sometimes	No	N/A
10. Have you improved/maintained your skills by participating in scheduled programs, i.e. Cooking Program, Exercise Classes, Crafts, Cognitive Games, etc	10. Have you improved/maintained your skills by participating in scheduled programs, i.e. Cooking Program, Exercise Classes, Crafts, Cognitive Games, etc Yes	10. Have you improved/maintained your skills by participating in scheduled programs, i.e. Cooking Program, Exercise Classes, Crafts, Cognitive Games, etc Sometimes	10. Have you improved/maintained your skills by participating in scheduled programs, i.e. Cooking Program, Exercise Classes, Crafts, Cognitive Games, etc No	10. Have you improved/maintained your skills by participating in scheduled programs, i.e. Cooking Program, Exercise Classes, Crafts, Cognitive Games, etc N/A
11. If yes, Have you been able to apply those skills in other areas of your life?	11. If yes, Have you been able to apply those skills in other areas of your life? Yes	11. If yes, Have you been able to apply those skills in other areas of your life? Sometimes	11. If yes, Have you been able to apply those skills in other areas of your life? No	11. If yes, Have you been able to apply those skills in other areas of your life? N/A
12. Do you access staff to help you work on personal goals?	12. Do you access staff to help you work on personal goals? Yes	12. Do you access staff to help you work on personal goals? Sometimes	12. Do you access staff to help you work on personal goals? No	12. Do you access staff to help you work on personal goals? N/A
13. Has your quality of life improved since joining this program? E.g. Personal goals, health, participation	13. Has your quality of life improved since joining this program? E.g. Personal goals, health, participation Yes	13. Has your quality of life improved since joining this program? E.g. Personal goals, health, participation Sometimes	13. Has your quality of life improved since joining this program? E.g. Personal goals, health, participation No	13. Has your quality of life improved since joining this program? E.g. Personal goals, health, participation N/A

Question Title

* Staff Relations

	Yes	Sometimes	No	N/A
14. Are the staff courteous to you?	14. Are the staff courteous to you? Yes	14. Are the staff courteous to you? Sometimes	14. Are the staff courteous to you? No	14. Are the staff courteous to you? N/A
15. Do the staff treat you with respect?	15. Do the staff treat you with respect? Yes	15. Do the staff treat you with respect? Sometimes	15. Do the staff treat you with respect? No	15. Do the staff treat you with respect? N/A
16. Are you satisfied with the level of support offered by staff when you need it?	16. Are you satisfied with the level of support offered by staff when you need it? Yes	16. Are you satisfied with the level of support offered by staff when you need it? Sometimes	16. Are you satisfied with the level of support offered by staff when you need it? No	16. Are you satisfied with the level of support offered by staff when you need it? N/A
17. Do you feel that the staff treat you as an equal?	17. Do you feel that the staff treat you as an equal? Yes	17. Do you feel that the staff treat you as an equal? Sometimes	17. Do you feel that the staff treat you as an equal? No	17. Do you feel that the staff treat you as an equal? N/A

Question Title

* Environment

	Yes	Sometimes	No	N/A
18. The Centre is open enough hours for me.	18. The Centre is open enough hours for me. Yes	18. The Centre is open enough hours for me. Sometimes	18. The Centre is open enough hours for me. No	18. The Centre is open enough hours for me. N/A
19. Do you like the location of the Centre?	19. Do you like the location of the Centre? Yes	19. Do you like the location of the Centre? Sometimes	19. Do you like the location of the Centre? No	19. Do you like the location of the Centre? N/A
20. Is the Centre kept clean?	20. Is the Centre kept clean? Yes	20. Is the Centre kept clean? Sometimes	20. Is the Centre kept clean? No	20. Is the Centre kept clean? N/A
21. Do you feel safe at the Centre?	21. Do you feel safe at the Centre? Yes	21. Do you feel safe at the Centre? Sometimes	21. Do you feel safe at the Centre? No	21. Do you feel safe at the Centre? N/A
22. I feel welcome at the Centre	22. I feel welcome at the Centre Yes	22. I feel welcome at the Centre Sometimes	22. I feel welcome at the Centre No	22. I feel welcome at the Centre N/A
23. Would you recommend the Centre to others?	23. Would you recommend the Centre to others? Yes	23. Would you recommend the Centre to others? Sometimes	23. Would you recommend the Centre to others? No	23. Would you recommend the Centre to others? N/A

Question Title

* Overall I would rate my satisfaction with the quality of the program as:

excellent

above average

average

below average

poor