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* 1. What is the name of the family day home agency?

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* 2. What is the current date?

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* 3. How long have you been contracted with the agency?

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* 4. Please state the name of the consultant assigned to your day home?

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* 5. I feel valued and supported by the agency.

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* 6. The referrals I get show that the agency carefully matches the care a family is looking for with what I offer in my day home.

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* 7. Professional development is encouraged and supported by the agency.

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* 8. The agency helps me learn about and connect with community support services and other providers.

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* 9. The agency provides resources (i.e. handouts, articles, etc.) and information to help me stay current with research on child development.

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* 10. My day home visitor/consultant encourages me to think about and assess my interactions with children and how I plan daily activities.

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* 11. I have regular opportunities to review my work performance with my day home visitor/consultant.

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* 12. The philosophy, policies and procedures and expectations of the agency were reviewed with me when I first contracted with the agency.

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* 13. Agency staff provided information about the regulatory standards that I am required to meet.

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* 14. I have, or know how to get, the information I need about agency policies and procedures.

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* 15. I have opportunities to provide input to policies and procedures that affect me.

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* 16. I feel comfortable approaching my day home visitor/consultant with a concern or a complaint.

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* 17. Agency staff are responsive to my requests for assistance.

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* 18. Are there any comments you would like to make?

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