Referral Source Survey

Name
Agency
Email

Yes
No

How often do you contact Elder Services of Berkshire County Inc.?

Once
Daily
Weekly
Monthly

To help us provide quality service to the elderly and their families, please rate the following.
Please answer only those sections that are relevant to you.



Overall communication

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Another staff person or an acceptable alternative is offered when staff are not available.
3. Telephone receptionist are courteous.
4. Telephone calls are answered within 6 rings.
5. Voice Mail is easy to use.
6. Faxes are easy to read.
7. ESBC mailings are easy to use.
8. Letters and written materials are clear.
9. Telephone receptionist direct calls appropriately.
10. Telephone messages / calls are returned within 24 hours.
11. ESBC's website is easy to use.
12. ESBC's website is informative.
13. Staff response to e-mails is prompt.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Communication is clear.
6. Communication gave me sufficient information to take action.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Information provided was useful.
6. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Quality of meals is good.
6. Meals were started within time frame you were told.
7. Meals are nutritious.
8. Meals satisfy most clients.
9. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Staff provide clear communication regarding housing options.
6. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Staff are well informed.
6. Information provided is clear.
7. Information provided is concise.
8. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Staff make a strong effort to meet client needs.
6. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Information provided was useful.
6. Problems or issues are addressed in a timely manner.
7. Staff are knowledgeable.
8. Staff follow through promptly on referrals.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
1. Staff are easy to access by telephone.
2. Staff are courteous.
3. Staff are responsive to your expressed needs.
4. Staff contact within 24 hours.
5. Volunteers are knowledgeable.
6. Staff follow through promptly on referrals.

Yes
No

1. Senior Aide Employment Program

Yes
No

Comments