1. 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.

* What centre are you a member with:

* General Feedback

* Programs

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

* 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
11. If yes, Have you been able to apply those skills in other areas of your life?
12. Do you access staff to help you work on personal goals?
13. Has your quality of life improved since joining this program? E.g. Personal goals, health, participation

* Staff Relations

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

* Environment

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

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

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