Survey - CRDI-TSA DP - English version

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* 1. In which installation did you receive care or services?

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* 2. What type of service did you receive?

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* 3. Date you received the service

Date

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* 4. Check the appropriate box.

	Yes	No	Not always	Does not apply
Did the personnel show you respect (courtesy, formal modes of address)?	Did the personnel show you respect (courtesy, formal modes of address)? Yes	Did the personnel show you respect (courtesy, formal modes of address)? No	Did the personnel show you respect (courtesy, formal modes of address)? Not always	Did the personnel show you respect (courtesy, formal modes of address)? Does not apply
Comments
Did the personnel get your consent (authorization) before beginning to provide care services?	Did the personnel get your consent (authorization) before beginning to provide care services? Yes	Did the personnel get your consent (authorization) before beginning to provide care services? No	Did the personnel get your consent (authorization) before beginning to provide care services? Not always	Did the personnel get your consent (authorization) before beginning to provide care services? Does not apply
Comments
Did the personnel explain the services you would be receiving?	Did the personnel explain the services you would be receiving? Yes	Did the personnel explain the services you would be receiving? No	Did the personnel explain the services you would be receiving? Not always	Did the personnel explain the services you would be receiving? Does not apply
Comments
Were the explanations about the services easy to understand?	Were the explanations about the services easy to understand? Yes	Were the explanations about the services easy to understand? No	Were the explanations about the services easy to understand? Not always	Were the explanations about the services easy to understand? Does not apply
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Did the personnel give you an opportunity to express your needs, comments or concerns?	Did the personnel give you an opportunity to express your needs, comments or concerns? Yes	Did the personnel give you an opportunity to express your needs, comments or concerns? No	Did the personnel give you an opportunity to express your needs, comments or concerns? Not always	Did the personnel give you an opportunity to express your needs, comments or concerns? Does not apply
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Were you given any written information? (e.g., symptoms to watch for, explanations of your condition, etc.)	Were you given any written information? (e.g., symptoms to watch for, explanations of your condition, etc.) Yes	Were you given any written information? (e.g., symptoms to watch for, explanations of your condition, etc.) No	Were you given any written information? (e.g., symptoms to watch for, explanations of your condition, etc.) Not always	Were you given any written information? (e.g., symptoms to watch for, explanations of your condition, etc.) Does not apply
Comments
If you were referred to another department for additional care, were you given adequate explanations of what would happen next? (e.g., from the emergency room to radiology, from the hospital to the CLSC or to home care, etc.)	If you were referred to another department for additional care, were you given adequate explanations of what would happen next? (e.g., from the emergency room to radiology, from the hospital to the CLSC or to home care, etc.) Yes	If you were referred to another department for additional care, were you given adequate explanations of what would happen next? (e.g., from the emergency room to radiology, from the hospital to the CLSC or to home care, etc.) No	If you were referred to another department for additional care, were you given adequate explanations of what would happen next? (e.g., from the emergency room to radiology, from the hospital to the CLSC or to home care, etc.) Not always	If you were referred to another department for additional care, were you given adequate explanations of what would happen next? (e.g., from the emergency room to radiology, from the hospital to the CLSC or to home care, etc.) Does not apply
Comments
After having told one staff member about your problem, did you have to repeat the same information to another staff member?	After having told one staff member about your problem, did you have to repeat the same information to another staff member? Yes	After having told one staff member about your problem, did you have to repeat the same information to another staff member? No	After having told one staff member about your problem, did you have to repeat the same information to another staff member? Not always	After having told one staff member about your problem, did you have to repeat the same information to another staff member? Does not apply
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Did you find the premises clean?	Did you find the premises clean? Yes	Did you find the premises clean? No	Did you find the premises clean? Not always	Did you find the premises clean? Does not apply
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Did you find the premises safe (e.g., unobstructed stairs, access to entrances, etc.)?	Did you find the premises safe (e.g., unobstructed stairs, access to entrances, etc.)? Yes	Did you find the premises safe (e.g., unobstructed stairs, access to entrances, etc.)? No	Did you find the premises safe (e.g., unobstructed stairs, access to entrances, etc.)? Not always	Did you find the premises safe (e.g., unobstructed stairs, access to entrances, etc.)? Does not apply
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Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) clean?	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) clean? Yes	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) clean? No	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) clean? Not always	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) clean? Does not apply
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Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) safe?	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) safe? Yes	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) safe? No	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) safe? Not always	Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) safe? Does not apply
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Were the signs in the building easy to follow to get where you needed to go?	Were the signs in the building easy to follow to get where you needed to go? Yes	Were the signs in the building easy to follow to get where you needed to go? No	Were the signs in the building easy to follow to get where you needed to go? Not always	Were the signs in the building easy to follow to get where you needed to go? Does not apply
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Did you see the personnel washing or desinfecting their hands before provinding care?	Did you see the personnel washing or desinfecting their hands before provinding care? Yes	Did you see the personnel washing or desinfecting their hands before provinding care? No	Did you see the personnel washing or desinfecting their hands before provinding care? Not always	Did you see the personnel washing or desinfecting their hands before provinding care? Does not apply
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Did the personnel make sure to properly identify you before providing care? (e.g., by asking for your name and date of birth)	Did the personnel make sure to properly identify you before providing care? (e.g., by asking for your name and date of birth) Yes	Did the personnel make sure to properly identify you before providing care? (e.g., by asking for your name and date of birth) No	Did the personnel make sure to properly identify you before providing care? (e.g., by asking for your name and date of birth) Not always	Did the personnel make sure to properly identify you before providing care? (e.g., by asking for your name and date of birth) Does not apply
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Would you know how to proceed if you wanted to file a complaint?	Would you know how to proceed if you wanted to file a complaint? Yes	Would you know how to proceed if you wanted to file a complaint? No	Would you know how to proceed if you wanted to file a complaint? Not always	Would you know how to proceed if you wanted to file a complaint? Does not apply
Comments

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* 5. Overall, how satisfied are you with the service you received?

0 %

100 %

Effacer

i We adjusted the number you entered based on the slider’s scale.

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* 6. What is your sex?

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* 7. What is your age?

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* 8. Survey completed by :

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* 9. Comments and suggestions

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* 10. If you would like us to contact you, please supply your contact information :

Last name, first name :

Phone :

Email :

A personal or family advisor is available to answer your questions at 418-723-4425 ext. 4633 or 1-866-470-4425

Do you want to file a complaint?
By telephone : 1 844-255-7568
On the Internet : www.cisss-bsl.gouv.qc.ca
By email : plaintes.cisssbsl@ssss.gouv.qc.ca

Rest assured that the information and comments you share with us will remain confidential.

Thank you for helping to improve the care and services offered at CISSS du Bas-Saint-Laurent!