SAMPLE: A COMPLETED SERVICE SHEET
Service 1: Community Services Information and Referral Line.
Description: A center and/or telephone line where community residents can find out about existing benefits, services, and programs and the procedures for obtaining or using them, and that helps people find other appropriate resources and sources of help.
A. Availability.
Check one:
____ This service is NOT available in our jurisdiction (county, region, city, neighborhood, state, etc.) or through another jurisdiction. (If ³this service is not available² is checked, go directly to Question D., below.)
x
____ This service IS available in our jurisdiction (county, region, city, neighborhood, state, etc.) or through another jurisdiction.
If you checked that the service IS available, briefly record/describe who provides the service in your jurisdiction OR where it is available to you from another jurisdiction:
The Countyıs United Way handles information and referral for the county. However, its database is made up primarily of its own member agencies. But it is updating the database to include other service providers.
|
B. Quantity. |
Meets None of the Need |
Meets Some of the Need |
Meets Half of the Need |
Meets Most of the Need |
Meets All Need |
|
Is enough of the service available to meet needs? |
0 |
1 |
2 |
3 |
4 |
|
C. Quality. |
Poor |
Occasionally Good |
Sometimes Good |
Often Good |
Always Good |
|
How effective; fam- ily-centered; cultur- ally sensitive, etc.? |
0 |
1 |
2 |
3
|
4 |
|
D. Importance. |
Not Important |
Would Be Nice |
Moderately Important |
Very Important |
Critically Important |
|
How important to develop/continue this service? |
0 |
1
|
2 |
3 |
4 |
E. Comments (Record facts or reflections that may be useful later in analyzing the results. Also, in regard to Question C [Quality], identify any independent sources of evaluation of the quality of the service, such as consumer satisfaction surveys, etc.):
United Way has some completed satisfaction surveys from community members who used its information and referral service.