Return to Work Process Satisfaction Survey

Return to Work Process Satisfaction Survey

Return to Work Process Satisfaction Survey

I’m conducting a survey of employees who participated in the RTW program in the past 5 years. Your feedback is important. It will help us to determine the effectiveness of the RTW services provided. Your answers will be kept strictly confidential. Your answers will be combined with answers from all other survey participants to form a general report. The survey should take approximately 10 minutes.

  1. First, please tell me if your involvement in a RTW program was as a result of :

Work relatedPersonal injury/illnessPersonal injury/illness

Injury or illness>5 day but < than 90 days> than 90 days

  1. Who first contacted you to discuss return to work? Please provide the person’s position only, not their name.
  1. Was the person above the one who coordinated your return to work process from date of first contact through to follow-up with you once you had returned to work?

YesNo

If no, please provide the title of the person who assisted you throughout your return to work process.

Please answer the following questions based on the individual who assisted you throughout your return to work process.

  1. I would like to get an idea of your overall satisfaction with the services you received during your RTW program? Please rate this on a scale of 1 to 5, where 1 means that you are not satisfied at all and 5 means you are very satisfied with the RTW services.

Not satisfiedVery Don’t

At allSatisfiedremember

12345

(For responses of 1 or 2)

Can you tell me why you say that?

  1. Think about the RTW plan that you participated in. Was the plan that you completed, the one that was initially proposed?

YesNo

If no, in what way was it different?

  1. How satisfied were you with the way your RTW coordinator (or individual who you dealt with) addressed your issues with the plan? Please rate this on a scale of 1 to 5, where 1 means that you are not satisfied at all and 5 means you are very satisfied with the RTW services.

Not satisfiedVery Don’t

At allSatisfiedremember

12345

  1. Overall, how satisfied were you with the plan you completed? Please rate this on a scale of 1 to 5, where 1 means that you are not satisfied at all and 5 means you are very satisfied with the RTW services.

Not satisfiedVery Don’t

At allSatisfiedremember

12345

  1. Did you experience any problems or challenges while completing your RTW plan?

YesNoDon’t Know/Remember

What problems did you experience?

  1. How helpful would you say your RTW coordinator (or other individual you dealt with) was throughout your RTW plan? By this I mean helpful with things like coordinating services, dealing with problems you were faced with and encouraging you through the process. Please rate this on a scale of 1 to 5, where 1 means that the RTW coordinator wasnot helpful at all and 5 means wasvery helpful.

Not helpfulVery Don’t

At allHelpfulremember

12345

Can you tell me why you say that?

  1. Overall, how satisfied were you with the services you received from your RTW coordinator (or other individual you dealt with)? Please rate this on a scale of 1 to 5, where 1 means that you are not satisfied at all and 5 means you are very satisfied with the RTW services.

Not satisfiedVery Don’t

At allSatisfiedremember

12345

  1. Did your RW coordinator (or other individual you dealt with) follow up with you after you returned to work? By follow-up I mean things like calls to find out how you were doing or what was happening with any job accommodations that were arranged?

YesNoDon’t Know/Remember

  1. How satisfied were you with the follow-up you received? Please rate this on a scale of 1 to 5, where 1 means that you are not satisfied at all and 5 means you are very satisfied with the RTW services.

Not satisfiedVery Don’t

At allSatisfiedremember

12345

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