Evaluation Form

Please rate how much you agree or disagree with the following statements.

1. I was able to speak to someone/schedule an appointment in a reasonable amount of time. *

2. The role of the Ombuds Office was clearly explained to me. *

3. The Ombuds Office listened to my questions and concerns. *

4. I was treated respectfully and professionally by the Ombuds. *

5. The Ombuds Office helped me identify and evaluate the options to address my concerns. *

6. I trust the Ombuds Office to maintain confidentiality. *

7. I feel the Ombuds Office did all s/he could to facilitate a fair process for the resolution of my dispute. *

8. Regardless of the outcome of my situation, my experience with the Ombuds Office was helpful. *

9. I was satisfied with my overall experience with the Ombuds Office. *

10. I would refer others to the Ombuds Office for help in resolving disputes, conflicts, or complaints. *

11. What worked best for you in your experience with the Ombuds Office?

12. How might your experience with the Ombuds Office have been improved?

13. My experience with the Ombuds Office is:

14. What would you have done if the services of the Ombuds Office were not available (check all that apply) ?

Would not have talked to anybody about the issue

Would not have brought up the issue as quickly

Would have left the organization

Would have changed positions in the organization

Would have filed a formal action (e.g., grievance, lawsuit, outside agency complaint)

OtherOther

15. As a result of my consultation with the Ombuds (check all that apply):

My issue is resolved

I am more aware of options available to me

I have a more clear view of the situation

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