Donette Steele, M.A. / Clinical Psychology

Work Experience - Sober Living Survey

Enter subhead content here

 

  Initial Impression of House by Interviewer

 

 

Date of Visit

 

Name of Sober Living Program

 

Contact Person in Program

 

Title

 

Address

 

City and Zip Code

 

Telephone Number with Area Code

 

Fax with Area Code

 

Email

 

 

 

1.  What is your overall impression of the neighborhood?   Good     Fair    Poor

 

      Why?

 

 

2.  What was your first impression of the Sober Living Home as you drove up?  Good  Fair  Poor

 

 

 

3.  Is the outside of the home being maintained and kept in good order?   Good   Fair    Poor

 

 

 

4.   What was your initial impression when you walked into the home?  (Cleanliness, odor etc.)

 

 

5.  Were you able to distinguish Staff from residents?  How?     Yes         No

 

 

6.  Did the staff acknowledge you and treat you in a professional manner?   Explain:

 

 

 

7.  If you were seek placement for yourself or a friend, would you consider this Sober Living Home?

 

 

8.  What are the positive attributes of this Sober Living House? Give specifics:

 

 

9.  What are the negative attributes of this Sober Living House? Give specifics:

 

 

 

10.  What is the overall condition of the Home?  Do things appear broken, not maintained or not clean?  

       Specifics:

 

 

11.  How friendly and opent to question did you find the staff?  Good     Fair     Poor

 

 

12.  List any further observations you have regarding the House.

 

 

 

13.  Would you recommend this House? 

 

 

14.  Any further comments related to the House?