EAP & Counseling Associates, PLLC
SUPERVISOR FOLLOW-UP SURVEY
P.O. Box 699
Shelby, NC 28151-0699
704-471-1332
704-481-1373 (Fax)
In order to maintain and improve services to you and the employees you supervise, please take a moment to fill out the survey and mail or fax to EAPC.
Employee Name ______Date ______Employer ______
1. When you referred the above employee to the program, what were the job-related issues? Check as many as apply.
1. None 5. Accidents 9. Personal Conduct 13. Insubordination
2. Absenteeism/tardiness 6. Impairments on the job 10. Difficulty w/peers 14. Gross Inefficiency
3. Quality/Quantity of work 7. Positive Drug Test 11. Disability 15. Worker’s Comp
4. Confusion/Concentration 8. DOT required 12. Threats/intimidation 16. Other ______
2. What disciplinary action was taken prior to the EAP referral? Check as many as apply.
1. None taken 4. Second warning 7. Terminated 10. Demotion
2. Oral Warning 5. Investigative status 8. Deferred action 11. Other ______
3. First written warning 6. Suspension without pay 9. Follow EAP recommendations or be terminated
3. How would you rate his/her overall job performance at the time of referral?
1. Outstanding 2. Above average 3. Average 4. Below Average 5. Unsatisfactory
4. How would you rate the following?
Initial contact with the EAP Staff? 1. Excellent 2. Good 3. Fair 4. Poor 5. Not applicable
Follow-up communication with the EAP staff? 1. Excellent 2. Good 3. Fair 4. Poor 5. Not applicable
Case was handled confidentially? 1. Excellent 2. Good 3. Fair 4. Poor 5. Not applicable
Overall satisfaction with the EAP? 1. Excellent 2. Good 3. Fair 4. Poor 5. Not applicable
5. This employee has:
1. Returned to an ______level of productivity
1. Excellent 2. Good 3. Fair 4. Poor 5. Not applicable
2. Not returned to an acceptable level of productivity 5. Resigned
3. Made some improvement in their work performance 6. Was terminated
4. Transferred to another department 7. Remaining Concerns ______
______
______
6. In order to serve you in your role as supervisor, are there specific skills that relate to dealing with trouble employees for which you need training?
1. Identification of performance problems 6. Team building skills
2. Communication skills 7. Referral techniques
3. Documentation Techniques 8. Conflict resolution techniques
4. Confrontation skills 9. Substance abuse awareness
5. Violence in the workplace 10. Other ______
7. Additional Comments: ______
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Thank you for taking the time to complete this survey. This is part of our commitment to deliver quality services to you, your company and your employees. If you have any questions or comments please call us at (704-481-1332).