Engagement Survey Instrument
Add Us In Evaluation
July 21, 2014
Submitted to:
U.S. Department of Labor
200 Constitution Ave., NW
Washington, DC 20210
According to the Paperwork Reduction Act of 1995, persons are not required to respond to this collection of information unless it displays a currently valid OMB control number and expiration date. Responding to this survey is voluntary. Public reporting burden for this collection of information is estimated to average 15 minutes, including time for reviewing instructions and completing and reviewing the information. Send comments regarding this burden estimate or any other aspect of this collection of information to Cherise Hunter, Office of Disability Employment Policy, U.S. Department of Labor: [email protected] or 202.693.4931.
Introduction
You are being asked to participate in a survey about your experience working with the [INSERT NAME OF ADD US IN CONSORTIUM HERE]. The U.S. Department of Labor’s Office of Disability Employment Policy (ODEP) has contracted with IMPAQ International to conduct this survey to assess the engagement of [INSERT NAME OF ADD US IN CONSORTIUM HERE] partners.
We are conducting this survey to determine how organizations work or collaborate with [INSERT NAME OF ADD US IN CONSORTIUM HERE], and whether they have experienced any change in how they think or what they do when they interact with people with disabilities. All the information you provide will be reported as aggregate or grouped data and will only be used for the purposes of this study.
Instructions for Completing the Survey
Please use only the Previous Page and Next Page buttons to go back to a previous question or move on to the next one. Please do not use the back and forward arrows in your browser for navigation.
Because the survey saves automatically each time you click “Next Page,” it is possible to close the survey and re-open it again at a future date. Just click on the link in your email again and it will take you to your partially completed survey with all completed pages saved.
Questions?
If you have any questions about completion of this survey or wish to receive your survey in an alternative format, please contact Ms. Lisa Lin Freeman of IMPAQ at 443-283-1648 or [email protected]. If you have any questions about the overall study, please contact Cherise Hunter of the Office of Disability Employment Policy, U.S. Department of Labor, at [email protected] or 202.693.4931.
Returning Completed Surveys
Please complete and submit your responses to this survey by no later than Month/Date/Year.
Thank you for your help in this effort to assess the impact of [INSERT NAME OF ADD US IN CONSORTIUM HERE]!
First, we will begin with some questions about you and your organization.
1. What is your role in your business/organization?
Executive Director/President/Administrator
Program Management/Oversight
Other
2. What type of business/organization are you in?
Government Agency
Workforce System
Vocational Rehabilitation Agency
Other Government Agency
For-Profit Business
Business or Industry Association
Educational Institution (K-12, College)
Nonprofit or Faith/Community-Based Organization
Labor Organization
Other
Please tell us about your involvement with [INSERT NAME OF ADD US IN CONSORTIUM HERE].
3. Within the past 12 months, how often have you had contact with anyone involved with _______________________________ [INSERT NAME OF ADD US IN CONSORTIUM HERE]?
Weekly or more often
At least once a month
Once every couple of months
Once or twice in past 12 months
Never (SKIP TO END)
4. How involved are you in the following [NAME OF ADD US IN CONSORTIUM] activities? |
Not at All |
A Little |
Some-what |
Moder-ately |
Very |
a. Strategizing |
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b. Recruiting businesses |
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c. Preparing businesses to hire individuals with disabilities |
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d. Recruiting individuals with disabilities |
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e. Preparing individuals with disabilities for employment |
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f. Matching individuals with disabilities with employer needs |
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g. Building relationships among businesses and community organizations |
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h. Evaluating [NAME OF CONSORTIUM] activities |
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i. Sustaining [NAME OF CONSORTIUM] activities |
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j. Disseminating [NAME OF CONSORTIUM] practices |
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5. Using the scale provided below, please indicate the extent to which you currently interact with each of the following partners in [NAME OF ADD US IN CONSORTIUM]1.
1 - Unaware:
Not aware of each other, No communication
2 - Awareness:
Aware of each other, Little communication
3 - Cooperation:
Provide information to each other, Little to moderate communication
4
- Coordination:
Moderate communication, Some shared decision making
5 -
Coalition:
Share ideas, Frequent communication, Work together in decision
making
6 - Collaboration: Have
mutual trust, Reach consensus on all decisions, Share ideas, Very
frequent communication
[INSERT SPECIFIC NAMES/ORGANIZATIONS] |
1 |
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5 |
6 |
Partner 1 |
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Partner 2 |
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Partner 3 |
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Partner 4 |
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Partner 5 |
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Other |
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[NOTE: if the response to all partners named in Q. 5 is “6,” skip to the end.
6. How likely you are to continue working with each of the following [NAME OF ADD US IN CONSORTIUM] partners?2 |
Very Unlikely |
Unlikely |
Neutral |
Likely |
Very Likely |
Not Appli-cable |
Partner 1 |
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Partner 2 |
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Partner 3 |
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Partner 4 |
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Partner 5 |
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Other |
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7. To what extent has your involvement with [NAME OF ADD US IN CONSORTIUM] increased or expanded your: |
Not at All |
Rein-forced Current Level |
A Little |
Moder-ately |
A Lot |
Level of community involvement |
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Access to leadership opportunities |
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Network of collaborative relationships |
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8. To what extent do you agree or disagree that3: |
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
Information sharing with [NAME OF CONSORTIUM] partners has increased my knowledge. |
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Combining knowledge with [NAME OF CONSORTIUM] partners has resulted in new ideas and solutions. |
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We often share work experiences with other [NAME OF CONSORTIUM] partners. |
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9. To what extent has your involvement with [NAME OF ADD US IN CONSORTIUM] partners changed how you think about employment of individuals in the consortium's targeted groups?
No Change |
Reinforced Attitudes I Already Had |
Changed a Little |
Changed a Moderate Amount |
Changed a Lot |
⃝ |
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10. To what extent has your involvement with [NAME OF ADD US IN CONSORTIUM] partner changed what you do about employment of individuals in the consortium's targeted groups?
No Change |
Reinforced Things I Was Already Doing |
Changed a Little |
Changed a Moderate Amount |
Changed a Lot |
⃝ |
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11. How much has [NAME OF ADD US IN CONSORTIUM] increased your organization's experiences in the following areas related to disability diversity? |
Not at All |
Rein-forced Current Level |
A Little |
Moder-ately |
A Lot |
a. Disability recruitment |
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b. Disability hiring practices |
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c. Disability diversity training practices |
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d. Accommodation practices |
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e. Customer pool |
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f. Level of community visibility |
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g. Involvement with peer organizations around disability issues |
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h. Policies inclusive of IWD |
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i. Marketing or outreach practices to include IWD |
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j. Disseminating consortium practices |
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k. Communication with members or customers about disability diversity |
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l. Programming for members or customers about disability diversity |
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m. Level of commitment to diversity by senior leadership and/or management |
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n. Level of resources committed to disability |
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o. New or modified policies or program directions to promote disability diversity |
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12. To what extent do you agree or disagree that your experience with [NAME OF ADD US IN CONSORTIUM] has helped you to: |
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
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13. Are there any other
ways – not
necessarily related to disability diversity – in
which your experience with [NAME OF ADD US IN CONSORTIUM] has changed
your behavior or resulted in changes in your organization or in the
larger community? Please describe.
Web
version will produce space to specify
14. Please describe what successes your organization has had in the employment of people with disabilities as a result of – or in connection with – your involvement with [NAME OF ADD US IN CONSORTIUM]. Web version will produce space to specify
1 Original question adapted by EconSys from the Collaborative Climate instrument developed by Sveiby and Simmons, 2002. Modified for current survey.
2 Original question (EconSys) based on the collaboration instrument from Frey, Lohmeier, and Tollefson, 2006. Modified for current survey.
3 Original question adapted by EconSys from the Collaborative Climate instrument developed by Sveiby and Simmons, 2002. Modified for current survey.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kay |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |