fewmany 0 Report Share Posted February 22, 2005 Hi everyone, I am looking for a survey form for our residents. This will help me find out if they want something more or is the activity program that I have meets all their needs. If you have a form please let me know, I have looked everywhere and had no luck. Thanks fewmany :hammer: Quote Link to comment Share on other sites More sharing options...
StacieO 0 Report Share Posted February 22, 2005 Here is a really basic survey I have used w/ my residents. I'm sure there are better ones out there, but we've found this works best w/ our population. I have tried surveys w/ more questions, but they don't answer all of the questions. ACTIVITIES SATISFACTION SURVEY 1. DO YOU PARTICIPATE IN GROUP ACTIVITIES OFFERED AT THE MANOR? ________YES _________NO 2. DO YOU FEEL YOU HAVE ENOUGH TO DO DURING THE DAY? ________YES _________NO 3. DO YOU ATTEND GROUP ACTIVITIES AFTER SUPPER? ________YES _________NO 4. DO YOU FEEL THERE ARE A VARIETY OF GROUP ACTIVITIES OFFERED AT THE MANOR? ________YES _________NO 5. PLEASE CHECK WHICH TYPES OF ACTIVITIES YOU ENJOY: ___MUSIC ___RELIGIOUS ___CRAFTS ___COOKING ___CURRENT EVENTS ___TRIPS/OUTINGS ___GAMES(cards/dice/BINGO) ___SOCIAL PARTIES ____INDEPENDENT ACTIVITIES Quote Link to comment Share on other sites More sharing options...
Diana 0 Report Share Posted February 22, 2005 Hi Guys, this is what I use. I got this from Bunny, though off the top of my head, I can't think of her website. She posts at http://www.senioract.com/wwwboard.html pretty often. This is all entact and I give her full credit for this survey. ACTIVIY INTEREST SURVEY In Order to make our Activities Program as responsive to your needs as possible, we ask that you take a few minutes to complete this survey. We’ll use the results to help guide us in formulating an activity schedule you’ll enjoy. Thanks for your time and input. In how many scheduled activities do you participate each week? _____ How many times a week do you require independent leisure materials? ____ (These are: magazines, crossword books, cards, movies, books, musical tapes, craft items) Are you satisfied with this level of participation? yes________ no _________ What are your three favorite activities? 1.____________________________ 2.____________________________ 3.____________________________ What activities would you like to see scheduled?_______________________________________________________________ ________________________________________________________________________ What time of the day do you prefer to have activities scheduled? Morning _____ Afternoon_____ Evening _____ Do you prefer activities ( check all that apply) Outdoors _____ Indoors______ Away from the Facility_____ Would you like to be involved in any capacity as a volunteer in the Activities Department? Yes contact me______ no thank you_____ Do you enjoy Entertainment arranged by Activities? yes________ no _______ What are your favorite types of entertainment? ________________________________________________________________________ Do you have any suggestions for the activities director? ________________________________________________________________________ Put a check after all of the following that might interest you. Art__ Crafts__ Bingo__ Bird Watching ___ Card Club ___ Gardening___ Music ___ Golf ___ Walking___ Picnics ___ Children Visits ___ Baseball ___ Tennis ___ Bowling ___ Glee Club___ Carnivals ___ Movies___ Book Club ___ Cooking ___ Teas____ Womens Club ___ Mens Club ___ Needlework ___ Travel ___ Socials ___ Visiting ___ Exercise___ Shopping___ Loteria___ Woodworking___ Horseshoes___ Poker___ Please deposit this survey at the front desk when it is completed. Thanks! Please add any additional comments to the back of paper. This document can be used several ways, to allow a new admission input, or to assess the success of your present program. I try to use it periodically with every resident a their needs/ interests can change. I keep a copy and just review it with them every year or so for long termers. For those in for just a short time, I might refer to it, and ask if they feel like trying a bit more now. Often they are very ill and do not feel up to much on admission. The first two questions allow you to do a few things: Get an idea of what they think their participation level is compared to the reality you know, to offer them the idea that all of their leisure activities do not have to be done in a group, and that you will provide them with items to use independently. I hope you find this form useful. Feel free to use adapt and change it to suit your needs. I reserve the right to puplication. It is my original form. Bunny ( Nancy Hahn) Quote Link to comment Share on other sites More sharing options...
Diana 0 Report Share Posted February 22, 2005 Oops, here's Bunny's website!!!! http://health.groups.yahoo.com/group/activ...shipforseniors/ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.