Corporate Client Survey

In an effort to continually improve our services we are asking all corporate clients to participate in an evaluation. Your honest responses will help us provide you with the best possible service.

 
COMPANY INFORMATION
Company Name Contact Name and Title
Company Mailing Address E-mail Address
Street Address Phone Number
City/Province/Postal Code Fax Number
 
Primary Contact Name
(if different from above)		 Title
Mailing Address E-mail Address
Street Address Phone Number
City/Province/Postal Code Fax Number
UTILIZATION REPORTS -- WHO SHOULD THESE BE DIRECTED TO?
Contact Name for Utilization Reports
(if not listed above)		 Title
Mailing Address E-mail Address
Street Address Phone Number
City/Province/Postal Code Fax Number
STAFF LISTS -- WHO SHOULD WE REQUEST THESE FROM?
Contact Name for Utilization Reports
(if not listed above)		 Title
Mailing Address E-mail Address
Street Address Phone Number
City/Province/Postal Code Fax Number
INVOICES -- WHO SHOULD THESE BE DIRECTED TO?
Contact Name for Utilization Reports
(if not listed above)		 Title
Mailing Address E-mail Address
Street Address Phone Number
City/Province/Postal Code Fax Number
Staff lists can be e-mailed to stafflists@humanacare.com (Excel format is preferred)
OTHER BRANCH OFFICE OR DEPARTMENT CONTACTS
Are there any other branch office or department contacts that we should have? (Please list below)


AWARENESS OF HUMANACARE AT THE WORKPLACE AND HOME MAKES FOR A SUCCESSFUL PROGRAM
How do you think HumanaCare could increase its visibility to your employees?
In House Training Session Brochures Electronic Communication
Posters Newsletters Cheque Inserts
Wallet Cards Magnets Other:
What kind of promotional items would you like to see from HumanaCare?
Would you like to be contacted to schedule a HumanaCare Employee Orientation Session? Yes No
Would you like more information regarding our Employee Satisfaction Survey Program? Yes No
HumanaCare has found that many employees appreciate the individual attention in receiving our Newsletters. Does your company currently receive our company newsletter? Yes No
a) If "Yes", is the quantity you are receiving adequate to suit your needs? Yes No
b) If "No", how many would you like to receive?
Would you like to receive an electronic copy of the newsletter? Yes No I already receive it via e-mail
Would you like electronic copies of the newsletters e-mailed to your staff? Yes No
If your answer is "Yes", please forward an email list to stafflists@humanacare.com (Excel format is preferred)
Would you be interested in Workshops and/or Lunch-and-Learns for your employees? Yes No
HumanaCare offers a wide range of Workshop and Lunch N Learn topics - Which topics would be of interest to your organization?
Please check all that apply:
Anger Management Assertiveness Humour/Laughter Managing Change
Parenting Post Traumatic Stress Eating and Nutrition Conflict Resolution
Stress Management Team Building Self Esteem Grief and Loss
Pre-Retirement Work/Life Balance Communication Financial
Coaching and Performance Smoking Cessation Other:
*Please note this list is not complrehensive and most topics can be modified to suit your work environment.
What are the geographical locations of all of your employees?
Do you have a link on your company website or intranet to HumanaCare's website? Yes No
Do you have Supervisory/Mandatory Referral Policies and Procedures in place? Yes No
Have you completed a Supervisory/Mandatory Referral training session conducted by HumanaCare?
Yes No
a) If "Yes", did the Supervisory/Mandatory referral session help in:
Identification of Performance Problems Documentation Techniques Confrontation Skills
Referral Techniques Other:
b) If "No", is this because you did not know that HumanaCare offered this service? Yes No
 
Are you aware of HumanaCare's Critical Incident Services? Yes No
What is your view of the primary function of an Employee and Family Assistance Program?
Do your employees have extended Health Care benefits? Yes No
a) If "Yes", please provide the following information:
Insurance Carrier:          Amount of Coverage:
Would you be interested in a Plaque or Certificate that states that your company has a HumanaCare EFAP?
Yes No
Do you feel that an Employee and Family Assistance Program is a valuable benefit for you, your family and your organization?
Very valuable Some value Little value No value at all
Overall how would you rate HumanaCare?
Excellent Good Fair Poor
We are looking for ways to improve. Do you have any comments or suggestions for us?