Consumer Satisfaction Survey - Working

Thank you for working with RSVP, Inc. Your satisfaction with our services is of the utmost importance. We welcome your feedback and suggestions.

Question Title

* 1. Please enter your name.

Name

Question Title

* 2. Please enter the RSVP, Inc. Specialist's Name

RSVP, Inc. Specialist's Name

Question Title

* 3. Please select the current service status:

Initial

Ongoing

Follow-Along

Case Closure

Please select the most appropriate response to the following statements.

Question Title

* 4. I have input when making a job choice.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 5. I feel like I was helped to get ready to work in the community.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 6. I was asked to participate with my job search.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 7. I like the job I obtained.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 8. I have learned new job skills.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 9. My job fits my interests.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 10. I have reliable transportation to and from my job.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 11. I am treated with respect on my job.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 12. I feel safe on my job.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 13. I have friends at work.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 14. I get along with my co-workers.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 15. I am satisfied with my salary.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 16. I am enjoying my job.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 17. I like working with RSVP, Inc. Specialists.

False

Somewhat False

Uncertain

Somewhat True

True

Question Title

* 18. I receive SSI/SSDI disability benefits.

Yes

Question Title

* 19. I am able to maintain my SSI/SSDI disability benefits?

Yes

Question Title

* 20. I receive Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

Yes

Question Title

* 21. I am able to maintain my Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

Yes

Consumer Satisfaction Survey - Working

Question Title

* 1. Please enter your name.

Question Title

* 2. Please enter the RSVP, Inc. Specialist's Name

Question Title

* 3. Please select the current service status:

Question Title

* 4. I have input when making a job choice.

Question Title

* 5. I feel like I was helped to get ready to work in the community.

Question Title

* 6. I was asked to participate with my job search.

Question Title

* 7. I like the job I obtained.

Question Title

* 8. I have learned new job skills.

Question Title

* 9. My job fits my interests.

Question Title

* 10. I have reliable transportation to and from my job.

Question Title

* 11. I am treated with respect on my job.

Question Title

* 12. I feel safe on my job.

Question Title

* 13. I have friends at work.

Question Title

* 14. I get along with my co-workers.

Question Title

* 15. I am satisfied with my salary.

Question Title

* 16. I am enjoying my job.

Question Title

* 17. I like working with RSVP, Inc. Specialists.

Question Title

* 18. I receive SSI/SSDI disability benefits.

Question Title

* 19. I am able to maintain my SSI/SSDI disability benefits?

Question Title

* 20. I receive Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

Question Title

* 21. I am able to maintain my Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

Question Title

* 22. I have out-of-pocket disability-related work expenses (i.e., transportation, medications, supplies, etc.)

Question Title

* 23. Things I like about my services/outcome:

Question Title

* 24. Things I do not like about my services/outcome:

Question Title

* 25. Date Survey Completed