Red = Required
FacilityWhich Facility do you work at:
Beloit Milton Waterford
Rate of PayMy rate of pay is fair for my position and consistent with other similar jobs in my area.
If Disagree, what do you think is a fair rate:
PositionOverall, how satisfied are you with your position at the facility?
Very Satisfied Satisfied Unsatisfied
If Unsatisfied, why?
Tell us what it would take to change your answer to Very Satisfied:
ProductivityWhat would help you be more productive and provide a higher level of service to our residents, families and visitors?
TrainingOn a scale of 1 - 10, with 1 being poor and 10 being excellent, how would you rate your training?
1 2 3 4 5 6 7 8 9 10
What changes could be made to make your training experience better?
Co-workersMy co-workers and I work well together. I enjoy working with them.
Strongly Agree Agree Sometimes Disagree Strongly Disagree
ManagementI am valued by my supervisor/management.
In regards to Feedback from your supervisor/manager, would you like:
More Ok as is Less
Company SuccessHow motivated are you to see the company succeed?
Company ImprovementsWhat inefficiencies do you see within the facility? How can we improve?
If you were an owner of this company, what would be the first three things you would change and why?
What does our facility do really well? What makes us stand out from the rest of assisted living facilities?
ReferralWould you recommend a friend/family to work/live at the facility?
In either case, why?
Any other feedback, good or bad?
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