Comment Forms - Donwood

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Comment Forms/Surveys/Surveys
Resident/Family Questionaire

Name of Resident:
Name of Individual Completing the Questionnaire:
Therapeutic Recreation Activities/programs that are provided to meet the physical, emotional and social needs of the resident. Note: Recreation calendars are available on each unit.
Are you familiar with the programs offered by the Therapeutic Recreation Department	Yes No
Based on the posted calendar, are there an adequate variety of scheduled programs?	Yes No
Are you satisfied with the services offered by the Therapeutic Recreation department?	Yes No
Comments/Suggestions for Therapeutic Recreation:
Housekeeping
Are resident rooms clean?	Yes No
Are public areas clean and tidy?	Yes No
Are you satisfied with the Housekeeping services?	Yes No
Comments/Suggestions for Housekeeping:
Laundry
Is the Laundry department providing clean clothing?	Yes No
Is laundry returned promptly?	Yes No
Are you satisfied with the Laundry Services department?	Yes No
Comments/Suggestions for Laundry:
Food Services
Do you know where the menu is posted?	Yes No
Based on the posted menu, does there appear to be a variety of food choices for residents?	Yes No
Is the dining room atmosphere pleasant?	Yes No
Are you satisfied with the services provided by the Food Services Dept.?	Yes No
Comments/Suggestions for Food Services:
Validation Code: