Form ETA 9124B ETA 9124B Host Agency Customer Satisfaction Survey

SCSEP Host Agency
Customer Satisfaction Survey

OMB Approval Number: 1205-0040
Expiration Date: 08/31/2018

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 about your experiences as a host agency over the
last twelve months. Please be completely honest. Your answers are strictly confidential. No one
in the agency will see your individual responses.
Please fill in your response to each answer like this:

, NOT this

Choose the number on the scale below each question that best represents your opinion. The last
two questions allow you to express your ideas about the program in your own words. Thank you
in advance for your help.
1. Utilizing the scale below, what is your overall satisfaction with the services provided by the
Older Worker Program/SCSEP? (Choose one number)
Very
dissatisfied
1

2

3

4

5

6

7

8

Very
satisfied

Didn’t
receive

10

90

9

2. Considering all of the expectations you may have had about the services of the Older Worker
Program/SCSEP, to what extent have the services met your expectations? (Choose one
number)
Fall
short
1

2

3

4

5

6

7

8

Exceed

Didn’t
receive

10

90

9

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
close
1

2

3

4

5

6

7

8

9

Very
close

Didn’t
receive

10

90

4. The Older Worker Program/SCSEP staff make the process of assigning participants easy for
me. (Choose one number)
Strongly
disagree
1

Strongly
agree
2

3

4

5

6

7

8

9

Please continue on other side

10

Don’t
know
90

ETA-9124 – Part B
(Rev. 2/28/2018)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB
control number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Completion of this survey is
completely voluntary, and information collected will be kept private to the extent permitted by law and used for program evaluation purposes only. Thank you for your
participation. 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, Office of Workforce Investment, Room C-4510, 200 Constitution Avenue, NW, Washington, DC 20210. (Please do not return surveys
to this address.)

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SCSEP Host Agency Customer Satisfaction Survey
5. The Older Worker Program/SCSEP staff who make the assignments have a good
understanding of my business needs. (Choose one number)
Strongly
disagree
1

Strongly
agree
2

3

4

5

6

7

8

9

Don’t
know

10

90

6. I receive sufficient information about the backgrounds of the participants assigned to my
agency. (Choose one number)
Strongly
disagree
1

Strongly
agree
2

3

4

5

6

7

8

9

Don’t
know

10

90

7. When Older Worker Program/SCSEP staff propose a participant for our agency, I understand
that: (Choose all that apply)
1) I can accept the individual offered or not
2) I have a choice among several potential participants
3) I really have no choice

8. The participants assigned are a good match with my agency. (Choose one number)
Strongly
disagree
1

Strongly
agree
2

3

4

5

6

7

8

9

Don’t
know

10

90

9. Would you like the participants to have been better prepared in any of these areas?
(Choose Yes, No, or N/A for each area)
1) Basic computer knowledge

Yes

No

N/A

2) Basic employability skills, like how to dress, how to interact
with co-workers and supervisors, and punctuality

Yes

No

N/A

3) Knowledge of what the assignment required

Yes

No

N/A

4) How to behave with the host agency’s customers or clients

Yes

No

N/A

10. The Older Worker Program/SCSEP staff are helpful in resolving any problems we have.
(Choose one number)
Strongly
disagree
1

Strongly
agree
2

3

4

5

6

7

8

9

10

Not
applicable
90

Please continue on next page
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SCSEP Host Agency Customer Satisfaction Survey
11. The Older Worker Program/SCSEP staff stay in touch with my agency throughout the
assignment to make sure it goes well. (Choose one number)
Strongly
disagree

Strongly
agree

1

2

3

4

5

6

7

8

9

Don’t
know

10

90

12. Do any of the older workers assigned to your agency require supportive services, such
as assistance with transportation, uniforms, safety equipment, or health services, to be
successful in their assignments? (Choose one answer)
None

Few

1

Many
2

Nearly all

3

Don’t know

4

9

13. Has the Older Worker Program/SCSEP removed any participants from your agency before
you thought they were ready to leave? (Choose one number)
Never

Occasionally

1

Frequently

2

Nearly always

3

Don’t know

4

9

14. Has your agency requested that the Older Worker Program/SCSEP remove a participant
because the participant was not working out?
Yes

No

Don’t know

15. How has your participation in the Older Worker Program/SCSEP affected the amount of
services your agency provides to the community? (Choose one answer)
Decreased
significantly
1

Somewhat
decreased
2

Neither decreased
nor increased
3

Somewhat
increased

Increased
significantly

4

5

Don’t
know
9

16. What is most valuable to you about the Older Worker Program/SCSEP?

Please continue on other side

3

17. Based on your experience, what changes would you recommend for the Older Worker
Program/SCSEP?

Thank you for taking the time to complete this survey.

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