Survey JAN Professional Interview

Customer Satisfaction Surveys and Conference Evaluations Generic Clearance

JAN Professional Interview revised 12.17.07

Job Accommodations Network (JAN) Customer Satisfaction Survey

OMB: 1225-0059

Document [doc]
Download: doc | pdf


Job Accommodations Network User Follow-Up Interview

Rehabilitation, Medical or Educational Professional

Interview Structure



SECTION I. INTRODUCTION AND INFORMED CONSENT…………………………………………………….2

SECTION II. OUTREACH………………………………………………………...……………………………………3

SECTION III. ACCOMMODATION OUTCOME………………………………………………………………….….4

SECTION IV. LEGISLATIVE OUTCOMES………………………………………………………………………….14

SECTION V. JAN WEB SITE………………………………………………………………………………………….15

SECTION VI. GENERAL USER SATISFACTION…………………………………………………………………...16


































Section I. Introduction and Informed Consent


Hello. My name is _____________________________. I am calling to invite you to participate in a research study being conducted by West Virginia University on behalf of the Job Accommodation Network or JAN.


On ______________________(date), you contacted JAN, either by phone or electronically to request information about ______________________________. During that consultation you indicated your willingness to participate in a follow-up interview. I have been hired by JAN to do follow-up interviews that will evaluate JAN services.


Have I reached you at an OK time to talk?

If Yes, continue

If No, “What would be a better time?”_______________________________________.


As you may be aware, JAN is a free consulting service that provides information about job accommodations, the Americans with Disabilities Act, and the employability of people with disabilities. The purpose of this follow-up is to evaluate JAN’s service and to identify ways that it could improve services to its clients.


This follow-up will take about 15 minutes of your time. The information that you provide to us will be kept confidential to the extent permitted by law. Any reports or articles about these follow-ups will describe results in a summarized manner so that you cannot be identified.


Your participation in this interview is voluntary. Your decision whether or not to participate will not affect the services you may receive from JAN. You may choose not to take part at all or you may choose to stop participating at any time, and you won’t be penalized or lose the ability to use JAN’s services.

There are no foreseeable risks to participating in this research study. There will be no personal benefit to participating in this study.


Do you have any questions at this point?


Do you wish to take part in the follow-up at this time?

If Yes, continue

If No, “Is there a better time in which you wish to take part in the follow-up?”_______

Section II. Outreach


1. How did you know to contact the Job Accommodation Network


(ALL THAT APPLY); [Interviewers FIELD CODE into the following categories]


a. Used JAN service before

b. Previous user of JAN service (specify if another employer)

c. JAN Website

d. Other website (not JAN website)

e. Internet search

f. Referral from:

Organization (list) ________________________

Government Agency (list) __________________

Company

DOL Call Center

EARN

JAN self-employment service

g. Friend/co-worker/word of mouth

h. Personal contact with JAN staff member

i. Rehabilitation professional

j. Medical professional

k. Educational institution

l. Union

m. Legal professional

n. Newspaper/magazine/book/professional journal article

o. Television (report or advertisement)

p. Listed in a directory

q. I&R Service

r. Conference

s. JAN Publication or Brochure

t. JAN presentation

u. Used JAN self-employment service before

v. Previous user of JAN self-employment service

w. JAN self-employment Website

x. JAN self-employment Publication or Brochure

y. Other (please specify): _____________________________________________________









Section III. ACCOMMODATION OUTCOME


"The following questions explore the outcomes of your consultation with JAN."


Ask only if PURPOSE OF CALL = WORK ACCOMMODATION

ELSE SKIP to SECTION III.E

W1. Was the accommodation you discussed with the JAN consultant about assisting your client in

a. applying for a job [application, interview]

b. being hired for a new job [already have job offer, maybe just started or hasn't yet started]

c. keeping a job [retention of a current employee]

d. promotion

e. other (explain: _________________________________________________)

f. DK

g. RF


W2.

a. Does this person have a physical, mental, or other health condition that substantially limits a major life activity other than working, such as breathing, thinking, walking, talking, seeing, hearing, and so on?


Yes

No (Go to Question W2c).


b. On a scale from 1 to 5, with 1 being not at all limited and 5 being substantially limited, please rate the degree to which the person’s physical, mental, or other health condition(s) limit their major life activities.


1 2 3 4 5 DK RF

Major life activities Major life activities

Not limited Substantially limited



c. Does this person have a physical, mental, or other health condition that substantially limits the kind or amount of work that he/she can do?


Yes

No (Go to Question 3)


d. On a scale from 1 to 5, with 1 being not at all limited and 5 being substantially limited, please rate the extent to which this person’s physical, mental, or other health condition(s) limits the kind or amount of work that he/she can do?


1 2 3 4 5 DK RF

Work Work

Not limited Substantially limited



e. On a scale from 1 to 5, with 1 being not limited at all and 5 being substantially limited, how limited is this person's functional ability to work without accommodations?


1 2 3 4 5 DK RF

Not limited Substantially limited in working


f. On a scale from 1 to 5, with 1 being not limited at all and 5 being substantially limited, how limited is this person's functional ability to work with accommodations?


1 2 3 4 5 DK RF

Not limited Substantially limited in working


W3. How many years had/has/have the employee been with the company? ___ . _


W4. What is the wage (by hour or annually) for this employee’s job?


a. by hour _______ and

how many hours does/did this employee (do/did you) work on average per week ________ OR


b. Annually_______________


IF DK, THEN,

Does this job usually pay

a. less than $10,000 per year

b. $10,000 - $20,000

c. $20,001 - $50,000

d. $50,001 - $100,000

e. More than $100,000


[If queried, interviewer may say "Because JAN is a service funded by the federal government, it is important for JAN to establish that they reach a wide range of individuals."]


W5. What is the employee's highest level of education

a. Did not complete high school

b. High school certificate (not high school diploma)

c. High school diploma or GED (code this if participant says "graduated from high school")

d. Associates degree (2 year degree)

e. Graduated from college (4 year degree)

f. Degree from graduate/professional school (e.g. MA, MBA, PhD, MD, JD)

g. DK

h. RF


W6. What is the employee's gender?

[Interviewers ask even if it seems evident]

[If queried, interviewer may say "Because JAN is a service funded by the federal government, it is important for JAN to establish that they reach a wide range of individuals.]

a. Male

b. Female

c. DK

d. RF


W7. What is the employee's race or ethnicity? (CHOOSE ALL THAT APPLY?)

Race

a. American Indian or Alaska Native

b. Asian

c. Black or African American

d. Native Hawaiian or Other Pacific Islander

e. White

f. Other

Ethnicity

g. Hispanic or Latino

h. Not Hispanic or Latino

i. DK

j. RF



W8. What is the employee's age?

a. less than 18

b. 18 - 25

c. 26 - 35

d. 36 - 45

e. 46 - 55

f. 56 - 65

g. 66 and over

h. DK

i. RF


W9. SKIP

W10. After your interaction with JAN, was an accommodation made? (Choose one of a-h)

a. Yes or No


  1. Implementation Pending (DECISION TO ACCOMMODATE MADE, BUT IMPLEMENTATION PENDING (EXPLAIN/Why?) __________


c. Decision pending (explain/Why?) _____________________________________________

d. No (Please explain why an accommodation was not made.) [Interviewer to query to make sure that the response includes the reason for rejecting the accommodation] __________________________________________________________________________

e. other (e.g., employee resigned) ______________________________________________ Please tell me briefly about that. _____________________________________

f DK

g. RF

h. N/A


10a. Who makes the decision whether the company will provide an accommodation? (mark all that apply)

a. Human Resources department

b. Personnel department

c. Legal department

d. Managers

e. Employee's supervisor

f. Other: _______________________________________


W11. Did this accommodation solution that (was made, is pending implementation, the decision is pending on, was rejected) include: [Repeat as necessary as preface to each item in table.]



Yes

No

Rejected

Pending

DK

RF


Made

Waiting






  1. Buying a product or piece of equipment (like software, or a tool)?

What specific products or pieces of equipment?

Has that accommodation been made?

Are you still waiting on implementation?






  1. Modifying a product or piece of equipment (like software, or a tool)

Please describe how the product or equipment was or will be modified?








  1. Modifying the worksite (like a ramp, lighting or mirrors)

Please describe the modifications to the worksite








  1. Changes to a work schedule (such as flex time, shift change, part time)

Please describe the changes to the work schedule

[Light duty = work schedule change if same job, reassignment of changed job title]








  1. Moving the employee to another job (or reassignment)

What type of work was employee doing before reassignment and what type is or will he be doing after reassignment.








  1. Changes in workplace policy

What workplace policies were modified?








g. Formal or Company Education of co-workers

Please describe how the company was/is going to educate co-workers










Yes

No

Rejected

Pending

DK

RF


Made

Waiting






h. Providing an interpreter, reader, job coach or personal attendant services?

Which services were provided

Has that accommodation been made?

Are you still waiting on implementation?






i. Providing information in an alternative format (e.g., large print, taped text, Braille, etc.)

What alternative formats were provided








j. Working from home or telework

What arrangements were made (# of hours in # hours/wk)








k. Are there accommodation solutions that we have not talked about? IF YES, Please specify










[IF ANY PARTS OF Q10 = MADE, Continue

Else SKIP TO QW14]


W12. On a scale of 1 – 5, how effective was the accommodation, with 1 being (not effective at all) and 5 being (extremely effective)?


1 2 3 4 5 8 = DK 9 = RF

not effective at all extremely effective



W13. Please describe why the accommodation was or was not effective?



IF ANY PARTS OF Q10 = MADE or PENDING, Continue,

Else Skip to Section III.E


W14. Approximately how much did the accommodation cost (or is predicted to cost)?

a. one-time cost _$____________OR

b. annually _$_____________

DK = 888,888 RF = 999,999


[IF QW14 = 0, THEN SKIP TO SECTION III.E]


W15. Who helped pay for the accommodation (or will help to pay)? (All the Apply)

a. Employer

b. Employee

c. Rehabilitation Services

d. Insurance Company

e. Other


If "Employer", ask:

15a. What was the employer's source of funding for this accommodation?

a. Departmental funds

b. Human Resources funds

c. Company general funds

d. Other: ___________________________________________


15b. Who has the authority in the company to authorize expenditure for accommodations?

a. Local managers/supervisors

b. Human Resources representatives

c. Corporate/General Management

d. Other: ___________________________________________



[IF ONLY ONE ANSWER TO W15, SKIP TO SECTION III.E]


W16. How much did (or will) each pay? (PERCENT OR $ AMOUNT)

a. Employer

b. Employee

c. Rehabilitation Services

d. Insurance Company

e. Other

SECTION EIII. Education Accommodation Section


"The following questions explore the outcomes of your consultation with JAN."


ASK ONLY IF PURPOSE OF CALL = EDUCATION ACCOMMODATION

Else Go To Section IV


E1. Was the accommodation you discussed with JAN about a student in

a. Elementary/Middle school K-8

b. High School 9-12

c. Technical Trade School

d. Higher Education - College or University level

e. Other (Please explain: ________________________________________________)


E2. Was this student

a. Currently enrolled in a degree or special certification program

b. Applying for a program

c. Other (Please explain: ________________________________________________)


E6. What is the student's gender? [Interviewers ask even if it seems evident]

[If queried, interviewer may say "Because JAN is a service funded by the federal government, it is important for JAN to establish that they reach a wide range of individuals."]

a. Male

b. Female

c. DK

d. RF


E7. What is the student’s race or ethnicity? (CHOOSE ALL THAT APPLY?)

Race

a. American Indian or Alaska Native

b. Asian

c. Black or African American

d. Native Hawaiian or Other Pacific Islander

e. White

f. Other

Ethnicity

g. Hispanic or Latino

h. Not Hispanic or Latino

i. DK

j. RF



E8. What is the student's age?

a. less than 18

b. 18 - 25

c. 26 - 35

d. 36 - 45

e. 46 - 55

f. 56 - 65

g. 66 and over

h. DK i. RF



E10. After your interaction with JAN, was an accommodation made? (Choose one of a-h).

a. Yes No


b. Implementation Pending (DECISION TO ACCOMMODATE MADE, BUT IMPLEMENTATION PENDING (EXPLAIN/Why?) __________


c. Decision pending (explain/Why?) _____________________________________________

d. No (Please explain why an accommodation was not made. - INCLUDE REASON FOR REJECTING ACCOM.) ____________________________

e. other (e.g., employee resigned) explain Please tell me briefly about that. _____________________________________

f. DK

g. RF

h. N/A



E11. Did this accommodation solution include: [Repeat as necessary as preface to each item in table.]



Yes

No

Rejected

Pending

DK

RF


Made

Waiting






a. Buying a product or piece of equipment

(like software, or a tool)?

What specific products or pieces of equipment?

Has that accommodation been made?

Are you still waiting on implementation?






b. Modifying a product or piece of equipment (like software, or a tool)

Please describe how the product or equipment was or will be modified?








c. Modifying the facility (e.g., ramps, bathroom modification, parking)

Please describe the modifications of the facility








d. Changes to student schedule

Please describe the changes to the student schedule








e. Changes to course or school policy (e.g., allow service animal, increase time to take exam)

What was the change to course or school policy








f. Providing interpreter, reader, scribe, or other service?

Which services were provided?








g. Providing information in an alternative format (e.g., large print, taped text, Braille, etc.)

What alternative formats were provided?








h. Are there accommodation solutions that we have not talked about? If YES, please specify.











[IF ANY PARTS OF QE11 = MADE, Continue Else SKIP TO QE14]


E12. On a scale of 1 – 5, how effective was the accommodation, with 1 being (not effective at all) and 5 being (extremely effective)?


1 2 3 4 5 8 = DK 9 = RF

not effective at all extremely effective



E13. Please describe why the accommodation was or was not effective?



[IF ANY PARTS OF QE11 = MADE or PENDING IMPLEMENTATION, Continue

ELSE Skip to Section IV]


E14. Approximately how much did the accommodation cost (or is expected to cost)?

a. one-time cost _$____________OR

b. annually _$_____________

DK = 888,888 RF = 999,999


[IF QE14 = 0, THEN SKIP TO SECTION IV]


E15. Who helped pay for the accommodation (or who help will pay)? (All that Apply)

a. School or Educational Institution

b. Rehabilitation Services

c. Insurance Company

d. Student or Family Member

e. Other: ________________________________________

[If ONLY ONE ANSWER, SKIP TO SECTION IV]


E16. How much did (or will) each pay? (PERCENT OR $ AMOUNT)

a. School or Educational Institution

b. Rehabilitation Services

c. Insurance Company

d. Student or Family Member

e. Other: ________________________________________





Section IV. Legislative Outcomes


ASK ONLY IF

Purpose of Call Code = WORK OR EDUCATION LEGISLATION or PUBLIC ACCOMMODATION

ELSE GO To Section V.


Legislation Information:

The next few questions ask about how you used the information about ADA or other laws that you received from JAN.


1. Did the information help you to understand the ADA or another law?

a. YES

  1. NO

  2. DK

  3. RF


2. Was the information used to argue for or make a policy decision?

[FOR WORK LEGISLATION: If interviewee asks for definition of a policy decision, interviewers may say: A policy decision means a change in the way that a company does business. This may include a change in employee guidelines, policies, and exceptions to policies.]

[FOR EDUCATION LEGISLATION: If interviewee asks for definition: "A policy decision means a change in the way educational services are delivered. This may include a change in guidelines, policies and exceptions to policies.]

[FOR PUBLIC ACCOMMODATION: If interviewee asks for definition: A policy decision means a change in the way that a company or government office does business. This may include a change in guidelines, policies and exceptions to policies.]


a. YES

  1. NO (SKIP TO Next Section)

  2. DK (SKIP TO Next Section)

  3. RF (SKIP TO Next Section)


3. What was the outcome of that policy decision?

a. the policy was changed

b. the policy was not changed

c. the decision about whether to change the policy is still pending

d. other. (Explain) _____________________________________

i. DK

j. RF


Section V. JAN Web site


A. User Satisfaction - Ease of Use


1. Have you visited the JAN website within the last year? [If queried, "JAN website is at: http://www.jan.wvu.edu/]


  1. YES [SKIP TO Q2]

  2. NO

  3. DK

  4. RF


2. On a scale of 1 to 5 with 1 being difficult and 5 being easy, how was the website to navigate?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)


[If response = "1", query "So, the website was difficult for you to navigate?"]


3. On the same scale, how was it for you to obtain the information that you needed from the website?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)


[If response = "1", query "So, it was difficult for you to get the information that you needed from the website?"]


4. What did you hope to find on the Website? ________________________________________


    1. Did you find it? Yes ____ No _____

IF NO, Please tell me more about that.___________________________________

Section VI. General User Satisfaction

The last few questions are more general. Please tell me...


1. On a scale from 1 to 5, with 1 being difficult to use and 5 as easy, how easy or difficult was it to contact JAN?


1 2 3 4 5 7. NA 8. DK 9. RF

(difficult) (easy)


[If response = "1", query "So, it was difficult for you to contact JAN?"]


2. On a scale of 1 to 5 with 1 being “not courteously” and 5 being “courteously,” how were you treated by the receptionist at JAN?


1 2 3 4 5 8 = DK 9 = RF

(not courteously) (courteously)


[If response = "1", query " "So, the JAN receptionist was not courteous?"]


Spontaneous Comments: ____________________________________________________________


3. On that same scale, how were you treated by the consultant at JAN?


1 2 3 4 5 8 = DK 9 = RF

(not courteously) (courteously)


[If response = "1", query "So, the JAN consultant was not courteous?"


Spontaneous Comments: ____________________________________________________________


4. On a scale from 1to 5, with 1 being "not understand" and 5 being "understood" , how well did the consultant understand your needs?


1 2 3 4 5 8 = DK 9 = RF

(not understand) (understood)


[If response = "1", query "So, the consultant did not understand your needs?"]


Spontaneous Comments: ____________________________________________________________








5. On a scale from 1 to 5, with 1 being “did not meet my needs at all” and 5 being “met my needs exceptionally well”, how well did the information that you received meet your needs?


1 2 3 4 5 8. DK 9. RF

(not at all) (exceptionally well)


[If response = "1", query "So, the information you received did not meet your needs at all?]


6. How could the services you received have better met your needs.



7. Where would you get the type of information that JAN provides if JAN did not exist?



8. Would you use the service again, if you needed information?

a. Yes b. No 8 = DK 9 = RF


9. Have you referred other people to JAN?


a. Yes

b. No


10. On a scale from 1 to 5, with 1 being "very unlikely to refer" and 5 being "very likely to refer", how likely would you be to refer other people to JAN?


1 2 3 4 5 8. DK 9. RF

Very unlikely Very likely



11. We would appreciate any comments or suggestions that you may have about JAN.




Thank you for your participation.


Professional 17

File Typeapplication/msword
File TitleJAN Survey
Authorschartz
Last Modified ByAnne Hirsh
File Modified2007-12-17
File Created2007-12-17

© 2024 OMB.report | Privacy Policy