This set of questions relates to your experience with the Employee Assistance Program (EAP).
. 
1. I called the EAP:     Monday thru Friday       OR      Saturday thru Sunday

2. I contacted EAP:      8:15 AM-12:00 PM     12:00PM-5:15PM      5:15PM-8:15 AM

Please select one answer: (1=strongly agree, 2=agree, 3=neutral, 4=disagree, 5=strongly disagree)

3. The EAP was easy to access.                    1     2     3     4     5

4. The counselor heard my concerns.             1     2     3     4     5

5. I would utilize the EAP again if necessary.  1     2     3     4     5

COMMENTS:
:

Did you receive a referral to a local resource from the EAP counselor?         Yes         No

If the answer is yes, please answer the questions below. If not, please skip to question 11.

These are questions about the provider:                       Provider Name:

6. How long did it take you to receive your first appointment?
    Less than 1 week   1-2 weeks    2-3 weeks     no appointment made

Please select one answer: (1=strongly agree, 2=agree, 3=neutral, 4=disagree, 5=strongly disagree)

7. I was treated in a courteous and professional manner      1     2     3     4     5
     by the office staff.

8. My presenting problems were adequately addressed       1     2     3     4     5

9. The provider established clear goals and objectives         1     2     3     4     5

10. I would utilize this provider again, if necessary                    1     2     3     4     5

COMMENTS:


  
Workplace Questions:

11. The assistance I received had a positive effect on my
      work performance                                                          1     2     3     4     5

12. I would recommend EAP to my co-workers.                  1     2     3     4     5

COMMENTS:




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