RAHC Health Professional Feedback Form Question Title * 1. Placement DetailsYour feedback is very important to us and will be used to further improve our services. Please answer the following questions First Name Last Name Question Title * 2. Health Service Name Ampilatwatja Health Centre Aboriginal Corp Anyinginyi Health Aboriginal Corporation Central Australian Aboriginal Congress Department of Health (Top End) Department of Health (Central and Barkly Region) Katherine West Health Board Mala'la Health Service Aboriginal Corporation Marthakal Homelands Health Service Miwatj Health Aboriginal Corporation Pintupi Homelands Health Service Red Lily Health Board Sunrise Health Service Urapuntja Health Service Wurli Wurlinjang Health Service Other (please specify) Question Title * 3. Clinic details Community / Communities name Reporting Manager name Question Title * 4. Please indicate your placement dates Placement Start Date Date Placement End Date Date Question Title * 5. Please select your Health Profession Audiologist Dentist Dental Assistant Dental Therapist General Practitioner Registered Nurse Registered Midwife Registered Nurse and Midwife Remote Educator Physiotherapist Question Title * 6. Is this your first placement? Yes No Question Title * 7. Overall, how would you rate your experience while on placement? Excellent Very good Average / good Poor Very poor Excellent Very good Average / good Poor Very poor Comments Question Title * 8. To what extent do you agree or disagree with the following statements regarding your experience with RAHC? Strongly agree Agree Neutral Disagree Strongly disagree The RAHC team responded to your queries in a professional and timely manner The RAHC team responded to your queries in a professional and timely manner Strongly agree The RAHC team responded to your queries in a professional and timely manner Agree The RAHC team responded to your queries in a professional and timely manner Neutral The RAHC team responded to your queries in a professional and timely manner Disagree The RAHC team responded to your queries in a professional and timely manner Strongly disagree You had appropriate access to cultural support and guidance while on placement You had appropriate access to cultural support and guidance while on placement Strongly agree You had appropriate access to cultural support and guidance while on placement Agree You had appropriate access to cultural support and guidance while on placement Neutral You had appropriate access to cultural support and guidance while on placement Disagree You had appropriate access to cultural support and guidance while on placement Strongly disagree You had appropriate access to clinical support and guidance while on placement You had appropriate access to clinical support and guidance while on placement Strongly agree You had appropriate access to clinical support and guidance while on placement Agree You had appropriate access to clinical support and guidance while on placement Neutral You had appropriate access to clinical support and guidance while on placement Disagree You had appropriate access to clinical support and guidance while on placement Strongly disagree Comments Question Title * 9. Did you feel safe/secure while on placement? – if not, please provide further details in comments Yes No Comments Question Title * 10. Would you be interested in another placement with RAHC? Yes No Question Title * 11. Would you like to hear from RAHC regarding your responses today? Yes No Question Title * 12. Do you agree to RAHC using your feedback for marketing purposes? Yes No If you are interested in another placement with RAHC please forward your dates of availability to your Workforce Officer or call the RAHC team on (08) 8942 1650 If you are experiencing any concerns or difficulties from your placement and you are not happy to discuss these with a RAHC Team member please contact the 24hours 7 day a week CRANAPlus Bush Support Service on 1800 805 391 Question Title * 13. Finally, are there any other comments regarding your placement experience? Done