Community Engagement Client Exit Feedback Survey

Client to complete when exiting the program

Njernda Aboriginal Corporation is committed to providing high quality care and services and meeting your needs. We value your feedback so that we can ensure we are meeting your individual needs and are providing you with all the information you need. Please let us know what we do well and where we can improve our services.

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* 1. Do you wish to remain anonymous?

YES

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* 2. If NO to Q1 please provide the information requested below?

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Are you providing feedback on another persons behalf?

YES

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* 4. If YES please provide details.

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 5. Are you the legal representative? ( Parent, Carer or Guardian of the person you are acting on behalf of in Q4)

YES

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* 6. Does the person of Q4 know you are providing feedback on their behalf?

YES

If No Why?

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* 7. Are we able to speak with the person who received the service?

YES

If No Why

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* 8. Please provide details of the service that this feedback concerns. You can check more than one box.

HACC PYP (Home & Community Care Program for younger people)

CHSP ( Commonwealth Home Support Program)

Pastoral Services

Stolen Gen

Youth Justice

Community Justice

Community Engagement - Family & Child support through sporting & Social events

Njernda Housing

Drug & Alcohol Counselling

Youth Health Promotion and Wellbeing

SAAP (Support Accommodation Assistance Program)

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* 9. Were you happy with the amount of information we gave you to understand your rights and responsibilities?

YES

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* 10. Do you need additional support to exercise your rights and responsibilities? You can check more than one.

The quality of service you can expect.

Your right to an advocate

Your right to privacy

The process for accessing your information

Informed consent

Feedback process

Complaints appeals an allegations

Interpreters and translation services

Your right to be free from abuse neglect and violence

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* 11. Have you been given enough information about the service / program you are undertaking?

YES

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* 12. Have you been supported to identify your strengths weakness and goals with the aim of building on these?

YES

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* 13. Have you been offered information or support to engage and participate with the community?

YES

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* 14. Do you feel you are adequately engaged in your service delivery?

YES

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* 15. Is your assessment and service delivery taking into account your age, ability, gender, identity, culture, religion or spirituality?

YES

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* 16. Were you offered a copy of your care plan?

YES

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* 17. For Parents, Carers or Guardians do you require more information to assist the development of your child?

YES

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* 18. Is there any way we can improve our service?

YES

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* 19. If YES, have you discussed these with your worker?

YES

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* 20. What would you like to happen as a result of providing this feedback?

Njernda Aboriginal corporation is committed to protecting your privacy. We collect and handle personal information that you provide on this feedback form for the purpose of investing and responding.
Njernda will only use your information in accordance with relevant privacy and other laws. in order for us to provide services to you, affectively and efficiently we may need to she your information with other staff members who deal with the matters identified in your feed back. if you choose to remain anonymous Njernda may be unable yo deliver the full rang if services you require. If you wish to contact the manger who is responsible for managing the personal information you provide on this form, please call 03 5480 6252 and ask for the manager of the department your services are delivered from.
Your also have the right to access your information and seek its correction under the Freedom of Information act 1982. For information about making a Freedom of Information application contact your manger or case worker on 03 5480 6252.

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* 21. I declare that this information is true and correct.

YES

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* 22. Please Date

Date / Time

Date

Thank you for taking the time to provide feedback about our service.