Customer satisfaction survey Are you satisfied with our work? We would appreciate your feedback regarding your contact with our Employee counsellor. Kindly complete the questions below. All information will be processed anonymously. Date: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 january february march april may june july august september october november december 2008 2009 2010 Name of Employee counsellor: Name of your organisation: Number of interviews: How easy was it to make an appointment with the Employee Counsellor (EC)? Choose... Greatly Fairly Sufficient Some None Did the meetings with the EC help you? Choose... Greatly Fairly Sufficient Some None Do you work now, after the meeting(s) with the EC, with more satisfaction than before? Choose... More Unchanged Less Not relevant How resilient are you (in work and private life) since having contact with the EC? Choose... More resilient Unchanged Less resilient, but more assertive Not relevant Did the EC refer you to another care services provider? Choose... Yes No If you were referred to another care services provider, did the referral contribute to the resolution of your problem? Choose... Greatly Fairly Sufficient Some None Not relevant Would you consider contacting the EC again in the future? Choose... Yes No Explanation: Comments: We appreciate your feedback! Mensenwerk bv Jos van Adrichem, director Rozenlaan 35, NL-2771 DB Boskoop The Netherlands