QUESTIONNIARE

reviwing a carer

1.    Does your care worker arrive on the time?

       please circle:   yes    no   sometime  

 2.     Do you feel uncomfortable with your care worker?

       Please circle:    yes    no   sometime      

       If yes, please explain why

3.    has your care worker ever shouted at you in a negative way

       Please circle:    yes    no   sometime   

4.    Does your care worker give you a choice

       Please circle:    yes    no   sometime   

5.    Have you ever scared of your care worker?

      Please circle:    yes    no   sometime   

6.    Do you feel  safe with your care worker ?

      Please circle:    yes    no   sometime   

 7.    Do you trust your care worker

       Please circle:    yes    no   sometime   

8.    Do you think your care worker is well organised

        Please circle:    yes    no   sometime  

 9.     Does your care worker help you by doing everything for you?

        Please circle:    yes    no   sometime