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pdfSCSEP Host Agency
Customer Satisfaction Survey
OMB Approval Number: 1205-0040
Expiration Date: 10/31/2010
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
dissatisfied
1
2
3
4
5
6
7
8
9
Very
satisfied
10
Didn't
receive
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
short
1
Exceeds
2
3
4
5
6
7
8
9
10
Didn't
receive
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
close
1
2
3
4
5
6
7
8
9
Very
close
10
Didn't
receive
90
4. The Older Worker Program staff gave me all the information I needed to understand the
Older Worker Program. (Choose one number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Not
applicable
90
5. The Older Worker Program staff made the community service assignment process easy for
me to use. (Choose one number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
90
Please continue on other side
ETA-9124 – Part B
(Revised September 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.)
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SCSEP Host Agency Customer Satisfaction Survey
6. The Older Worker Program staff that made the assignment had a good understanding of my
business needs. (Choose one number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
90
7. I received sufficient information about the work history and education of the participant
assigned to my agency. (Choose one number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
90
8. I had sufficient choice about the participant assigned to my agency. (Choose one number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
90
9. The participant assigned to my agency had the necessary computer skills. (Choose one
number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
90
10. The participant assigned to my agency was a good match with my agency. (Choose one
number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
90
11. The Older Worker Program staff was helpful in resolving any problems I had. (Choose one
number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Not
applicable
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
None
2
Few
3
Some
4
Nearly all
9
Don’t know
Please continue on next page
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SCSEP Host Agency Customer Satisfaction Survey
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
Don’t know (Skip to question #16)
No (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
Never provides
additional training
2
Sometimes provides
additional training
3
Often provides
additional training
4
Always provides
additional training
9
Don’t know
16. The Older Worker Program staff stayed in touch with my agency to make sure the
assignment went well. (Choose one number)
Strongly
disagree
1
2
3
4
5
6
7
8
9
Strongly
agree
10
Don’t
know
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
Never
2
Occasionally
3
Frequently
4
Nearly always
9
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
Decreased
Significantly
2
Somewhat
Decreased
3
Neither Decreased
nor Increased
4
Somewhat
Increased
5
Increased
Significantly
9
Don’t
know
19. Would you recommend the services of the Older Worker Program to other agencies?
(Choose one number)
Definitely
no
1
2
3
4
5
6
7
8
Definitely
yes
9
10
Don’t
know
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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| File Type | application/pdf |
| File Title | HOST AGENCY CUSTOMERS |
| Author | BARRY A GOFF |
| File Modified | 2010-10-14 |
| File Created | 2010-10-13 |