Disability Program - Community Employer Please read the following statements and check the most appropriate response based upon the past 6 months of individual's employment Question Title * 1. Business Name: Question Title * 2. Employee Name: Question Title * 3. Date Employed: Question Title * 4. Person Completing Survey: Question Title * 5. Date Survey Completed: Question Title * 6. Before the employee started, Goodwill provided adequate information and answered questions about their services. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 7. Goodwill's staff provided assistance and training to other employees regarding working with the new employee if it was needed. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 8. If a job coach was used, did he/she offer training and support to the employee so that he/she can complete the job and related duties to my standards. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 9. Goodwill staff has been responsive to our questions and/or concerns. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 10. The services provided by Goodwill have been prompt. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 11. Goodwill staff has been courteous and professional. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 12. There is open communication between our business and Goodwill. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 13. I would contact Goodwill if another position opened up in our agency. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 14. Our business is satisfied with the ongoing support services provided by Goodwill. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 15. Goodwill assisted in making necessary modifications or accommodations to enable the employee to maintain an optimum level of independent employment. Strongly Agree Agree Neutral Disagree Strongly Disagree Question Title * 16. I would be interested in being a referral to possible employers of individuals who have disabilities. Yes No Question Title * 17. Are there any other needs that Goodwill can assist you in addressing with the employee? Question Title * 18. Use the following rating scale of 1 to 5 (5 being the highest rating) to evaluate the employee according to competitive employment standards.Co-worker relations Question Title * 19. Cooperation with Supervisor Question Title * 20. Punctuality/Attendance Question Title * 21. Remembers job details Question Title * 22. Motivation Question Title * 23. Stamina Question Title * 24. Quality of work Question Title * 25. Attitude Question Title * 26. Follows safety rules Question Title * 27. Additional Comments: Question Title * 28. How likely are you to recommend Goodwill to other colleagues/friends? 1 2 3 4 5 6 7 8 9 10 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 1 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 2 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 3 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 4 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 5 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 6 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 7 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 8 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 9 Please rate on a scale of 1 to 10, with 10 being the most likely to refer others. 10 Done