ETA-9124B Host Agency Survey - Customer Satisfaction

SCSEP Host Agency OMB Approval Number: 1205-0040

Customer Satisfaction Survey Expiration Date: 04/30/2014

HOST AGENCY CUSTOMERS

The Older Worker Program, also known as the Senior Community Service Employment Program (SCSEP), wants to provide the highest quality services to its customers. You can help improve services by answering the following questions. Please be completely honest. Your answers are strictly confidential. No one in the agency will see your individual responses. Unless directed otherwise, please answer based on your most recent experience with the Older Worker Program.

Choose the number on the scale below each question that best represents your opinion. Thank you in advance for your help.

1. Utilizing the scale of 1 to 10 below, what is your overall satisfaction with the services provided by the Older Worker Program? (Choose one number)

Very Very Didn't
dissatisfied satisfied receive

1 2 3 4 5 6 7 8 9 10 90

2. Considering all of the expectations you may have had about the services of the Older Worker Program, to what extent have the services met your expectations? (Choose one number)

Falls Exceeds Didn't
short receive

1 2 3 4 5 6 7 8 9 10 90

3. Now, think about the ideal services for people in your circumstances. How well do you think the services you received compare with the ideal services? (Choose one number)

Not at all Very Didn't
close close receive

1 2 3 4 5 6 7 8 9 10 90

4. The Older Worker Program staff gave me all the information I needed to understand the Older Worker Program. (Choose one number)

Strongly Strongly Not
disagree agree applicable

1 2 3 4 5 6 7 8 9 10 90

5. The Older Worker Program staff made the community service assignment process easy for me to use. (Choose one number)

Strongly Strongly Don’t
disagree agree know

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1 2 3 4 5 6 7 8 9 10 90

ETA-9124 – Part B

(Revised April 2010)

Your responses are confidential, and we appreciate your time and assistance.   This voluntary information has been approved by the Office of Management and Budget under OMB approval number 1205-0040.   Without this approval, we would not be able to conduct this survey.   The time needed to complete the survey is estimated to average ten (10) minutes.  If you have any comments regarding this estimate or any other aspect of this survey, including suggestions for reducing this burden; please send them to the U.S. Department of Labor, Division of Adult Services, Room S-4209, 200 Constitution Avenue, NW, Washington, DC 20210. (Please do not return surveys to this address.)

6. The Older Worker Program staff that made the assignment had a good understanding of my business needs. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

7. I received sufficient information about the work history and education of the participant assigned to my agency. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

8. I had sufficient choice about the participant assigned to my agency. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

9. The participant assigned to my agency had the necessary computer skills. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

10. The participant assigned to my agency was a good match with my agency. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

11. The Older Worker Program staff was helpful in resolving any problems I had. (Choose one number)

Strongly Strongly Not
disagree agree applicable

1 2 3 4 5 6 7 8 9 10 90

12. Did any of the older workers assigned to your agency require supportive services, such as assistance with transportation, medical care, or housing, to be successful in their assignments? (Choose one answer)

Yes No (Skip to question #14) Don’t know (Skip to question #14)

13. If the answer to question 12 is “Yes,” to what extent did the Older Worker Program provide the participants the supportive services they needed? (Choose one number)

1 2 3 4 9
None Few Some Nearly all Don’t know

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14. Do participants assigned to your agency ever need any kind of additional training other than the on-the-job training that comes with their assignment? (Choose one answer)

Yes No (Skip to question #16) Don’t know (Skip to question #16)

15. If the answer to question 14 is “Yes,” does the Older Worker Program provide the needed training? (Choose one number)

1 2 3 4 9
Never provides Sometimes provides Often provides Always provides Don’t know
additional training additional training additional training additional training

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16. The Older Worker Program staff stayed in touch with my agency to make sure the assignment went well. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

17. Did the Older Worker Program ever attempt to remove any participants from your agency before you thought they were ready to leave? (Choose one number)

1 2 3 4 9
Never Occasionally Frequently Nearly always Don’t know

18. How has your participation in the Older Worker Program affected your agency’s ability to provide services to the community? (Choose one answer)

1 2 3 4 5 9
Decreased Somewhat Neither Decreased Somewhat Increased Don’t

Significantly Decreased nor Increased Increased Significantly know

19. Would you recommend the services of the Older Worker Program to other agencies? (Choose one number)

Definitely Definitely Don’t
no yes know

1 2 3 4 5 6 7 8 9 10 90

20. For how long have you been a host agency? _______ (years; enter “1” if less than one year)

21. What do you think is most valuable about the Older Worker Program?

________________________________________________________________________

________________________________________________________________________

22. What part of the Older Worker Program do you think is most in need of improvement?

________________________________________________________________________

________________________________________________________________________

Thank you for taking the time to complete this survey.

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