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Guide to User-Led Reviews

10. Sample questionnaire

The following is a list of questions you could include in the questionnaire.  Obviously there are likely to be others depending on the type of service you provide.

Wherever possible each question should only need a “yes”, “no” or “not sure” answer.  Where appropriate allow space, usually just two or three lines, for comments and suggestions about any service gaps or shortcomings – as shown in questions two and three below.

1. Do you know what services we provide?
   Yes / No / Not sure
2. Is the service physically accessible to you?
   Yes / No / Not
   Comment/Suggestion
   
   
   
3. Is the inside of the building accessible and adequate for you?
   Yes / No / Not sure
   Comment/Suggestion
   
   
   
4. Is the service available at times that suit you?
   
   
5. Is the service flexible enough in terms of how, when or where it is provided?
   
   
6. Have you found that staff have the knowledge to meet your needs?
7. Have you found that staff have appropriate attitudes – are they helpful, polite, and sensitive?
8. Has information been available in the formats you need?
9. Has the information or advice you have received been accurate?
10. Has the information or advice you have received been independent?
11. Has the service been provided to you in a confidential way?
12. Has the information or advice you have received met your needs?
13. Has the service done what it said it would do? For example, written a letter on your behalf or phoned you back with information gathered.
14. Has the service done what it said it would do in the agreed timescale?
15. If you have asked for information which the service holds about you, was it provided?
16. Have you ever found that staff cannot deal with your enquiry or refer you to an agency which can?
17. If staff have referred you to another agency, has that agency been able to help you?
18. Have you ever found that staff cannot remember or find information about an earlier enquiry you made which you need to follow up?
19. Have you ever complained?
20. If you have complained, have you found the complaints system to be satisfactory?
21. Do you feel well-informed about any changes to the service or plans for future changes?
22. Do you feel properly consulted about any changes planned for the service?
23. Do you feel that if you have anything to say about the service you are listened to, have an influence, and continue to feel comfortable using the service?
24. Any other comments?

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Page updated 08.10.2007