Resident Satisfaction Survey Template
Section 1 of 7 · 4 questionsHouse Keeping And Building Services
Does the home share information that promotes client safety?
Opportunities are available for input/feedback into resident care
Opportunities are available to provide input/feedback into programs and services
Opportunities are available for input/feedback into home operations
Section 2 of 7 · 4 questionsInfection, Prevention And Control
You receive appropriate education and information regarding Infection Prevention and Control, Covid and visitation restrictions at the home
You were informed and educated on hand hygiene techniques
You were shown how to don and take off your personal protective equipment (gloves, gowns, masks, eyewear)
Do you feel safe at the home?
Section 3 of 7 · 8 questionsResident Care
There are opportunities for my involvement in decisions relating to my care
Food served is in line with my choices / dietary requirements and of good quality & variety
Personal care (bathing, grooming, dressing) is sensitive and appropriate
Going to the bathroom – staff respect my privacy and dignity
My privacy is respected
My choices and wishes are respected
My abilities and strengths are supported and encouraged
I can express my opinion without fear of consequences
Section 4 of 7 · 10 questionsStaff & Services
Staff listen to me
PSW staff are available, helpful and care for me
Registered staff are available, helpful and care for me
Physicians are available, helpful and care for me
A good quality and variety of recreational programs are offered
A good quality and variety of spiritual and religious programs are offered
If you are receiving social services, does the quality of the program leave you happy?
If you are currently receiving therapy services, is the quality of the program (physio/ occupational/ speech) leave you happy?
Do the volunteers’ services in the home leave you happy?
Recreation staff are available and helpful
Section 5 of 7 · 2 questionsAdministration
Efficiency in dealing with my finances/accounting
Availability and helpfulness of the Administration Staff
Section 6 of 7 · 4 questionsGeneral
Cleanliness of the home
General repair and upkeep of the building and grounds
Laundry services
Availability and helpfulness of the Housekeeping, Laundry and Building Services staff
Section 7 of 7 · 6 questionsOverall
Food choices
Food quality
Dining experience
Food quantity
Availability and helpfulness of the Food Services Staff
Please indicate your overall rating of the home as a place to live
Checklist by GoAudits. This checklist is an example: we do not guarantee compliance with the laws applicable to your territory or industry. Seek professional advice to adapt it to your workplace or jurisdiction.
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