CRI Agency Model
Staffing Survey

 

Please take a few moments to complete the Consumer Satisfaction Survey below. CRI is dedicated to providing quality services and would like to know how we are doing. If you have any additional comments please let us know at the bottom of the survey.  As always we greatly appreciate your input.

* Required

Title DR MISS MR MRS MS

First Name *

Last Name *

Email Address *

What is the after hour on call contact number? *

What is the name of the PCA Supervisor? *

When do you contact when you need a change in your schedule? *

Please answer the following ten questions with one of the following responses: Strongly Disagree  *  Disagree  *  Undecided  *  Agree  *  Strongly Agree I recieve my new schedule in advance. *

I am notified in advance of schedule and/or PCA changes. *

My questions, complaints, and concerns are addressed in a timely and professional manner. *

The scheduled PCA arrives and departs according to the times listed on the schedule I recieve. *

The PCA's are adequately trained to meet my personal care needs. *

The PCA's are adequately trained to meet my ancillary needs (light housekeeping, laundry, shopping, and meal preparation). *

I have had PCA's not show up for scheduled shifts. *

I am notified when a new PCA will be training in my home. *

The PCA's conduct themselves in a professional manner while in my home. *

The PCA's take excessive breaks and/or has excessive cell phone usage. *

Please list any additional comments or concerns below: