Workplace Needs Assessment

Workplace Needs Assessment

Booking Pack

Employers

Name of Organisation: ………………………………………………………………….

Name of Person Booking Assessment:…………………………………………….

Name of Person to be Assessed:………………………………………………………

Please read the information sheet that accompanies this booking pack carefully as this will provide important information about the type of assessments available, the assessment process and what to expect, and answers to other frequently asked questions.

The Assessment Booking Process:

Workplace Needs Assessment
Employer’s Booking Form /

Thank you for choosing the British Dyslexia Association for your assessment.

To book your assessment, please fully complete the documents within the booking pack and return it to us as per the instructions at the bottom of the form.

BDA Office use only:
Booking Reference: / Account Code T17
Details of Booking
Name of Main Contact:
Address (workplace):
Telephone number:
Email:
Name of Client (person being assessed):
Client contact details: / Tel:
Email:
Service required: / Workplace Needs Assessment
Description and quantity: / 2 hour assessment plus report
Location of assessment:
Date of Previous Diagnostic Assessment:
Further information and/or preferences:
Please make a note of any information that you feel that we or the assessor may need to know in advance of the assessment. Please also supply the most recent previous diagnostic report, if possible.
Specialist Workplace Assessor £375.00 plus VAT @ 20% = £450

Method of Payment:

Invoice (see below) / ☐ / Card (see below) / ☐
Total amount to be paid: / £

Please note that card payment will be taken once an assessment date has been agreed.

Payment details: Invoice

Name:
Position in company:
*Accounts Email:
Company Name:
Address:
*Purchase Order number:
For confidentiality purposes we will not put the Client’s name on our invoice to you unless requested on this booking form.

* required field

Payment details: Credit Card

Please debit my account for the amount of: / £
Card type: / Visa ☐ / Mastercard ☐ / Switch/Maestro ☐ / Delta ☐
Please provide card number & details:
For Maestro cards insert the whole of the long number which appears across the middle of the card
/ / /
Valid From Date / Valid To Date / Switch / Maestro Issue No. / Switch / Maestro
Start Date
Name as it appears on the card:
Cardholder’s signature: / Date:

Terms and Conditions for Workplace Needs Assessments

Booking a Workplace Needs assessment:

The B.D.A. will act as liaison between the assessor and the client for the purposes of booking the assessment.
The B.D.A. reserves the right to change the assessor allocated if the assessor should become unavailable for any other reason.
In order to book the assessment your personal information and the information contained within the booking pack will be passed onto the assessor in order for them to carry out the assessment.

The BDA is committed to protecting the privacy of individuals. Accordingly, all personal data collected will be subject to our Privacy Policy. For more information please see our website.

Following the assessment and the compilation of the final assessment report all client questionnaires, all raw data test sheets and all other personal data will be permanently deleted/destroyed.

Your final assessment report will be held by the BDA for 7 years [within your customer record file]. During this time you will be able to ask for an electronic copy of the report Please note there may be an administration charge for this. We would therefore strongly recommend that you keep a copy of your report securely. After this time the BDA will not be able to supply you with a copy of your report.

Should you require a copy of your assessment report [and/or the personal data in your customer record]; or for your report to be permanently deleted; or for changes/corrections made to it before this time; or to make a complaint, please notify us at:

How your information will be used:

From time to time we may like to send you information about our own products and services that you might be interested in, by post, telephone, email and SMS. We will not pass your information on to any organisation external to the BDA. If you agree to being contacted in this way, please tick the relevant boxes to indicate all of the means by which you would like to be contacted.

PostPhone EmailSMSphone call

The BDA is committed to protecting your personal data please see our Privacy Policy on our website

If you need any further information please write to us at:

Payment details:

Payment details must be received before a booking can be processed.
If paying via Company Purchase Order we need a valid purchase order number to invoice against and payment must be received before the assessment report is released.

Cancellation policy:

Cancellation by the Client or Main Contact
All changes and cancellations must be notified in writing to: .
Cancellation charges will be applied as follows:
Cancellation/reschedule within 14 days of a booked session = 50% of fee due;
Cancellation/reschedule within 24 hours of a booked session = 100% of fee due.
Cancellation by the B.D.A.
In the event that severe weather or any other emergency results in the cancellation of a session, the B.D.A. will endeavour to give clients a minimum of 24 hours’ notice* and to reschedule the assessment
*Please note that it is the client’s responsibility to provide the B.D.A. with an emergency contact number at which they will normally be available.

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I agree to abide by the terms and conditions as laid out above.

Name (print): / Signature: / Date:

Please return this booking pack by email to to enable us to check the details and make provisional contact with the most appropriate assessor.

How did you hear about the BDA

Website BDA Helpline Email Hardcopy Flier social media

Recommendation Other please state ______

Locations our Assessors Cover

Please indicate the location for your assessment. To carry out a Workplace Needs Assessment wherever possible the assessor will need to meet with you at your workplace.

We have assessors within a 40 mile radius of the following locations.Some assessors will travel further to carry out assessments, however if this is the case then we will need to charge you travel expenses. Expenses will be charged at 2nd Class Rail Fare or at 40 pence per mile.

Assessor locations (includes a radius of 40 miles from all specified town/city locations): / Please indicate your workplace location
Berkshire
Birmingham
Bridgewater
Bristol
Cambridge
Cheshire
Chester
Essex
Hampshire
Herefordshire
Hertfordshire
Gloucestershire
Kent
Liverpool
London (All Areas)
Manchester
Middlesex
Midlands - West
Midlands – South West
Monmouthshire
Newport (Gwent)
Norfolk
Northamptonshire
North Wales
Nottinghamshire
Oxfordshire
Surrey
Sussex
Suffolk
Somerset
Southampton
West Midlands
West Yorkshire
Worcestershire
Yorkshire

Are there any dates that you are NOT available?.......

Your Name:Date:

Employee Name:

Pre-Assessment Questionnaire for Employer

Thank you for completing this questionnaire. It is very helpful to have feedback from more than one perspective on what the employee finds more challenging. Everything you include in this response will be treated entirely confidentially and only used for the purpose of forming a more complete picture of the individual being assessed.

If the employee is having a diagnostic assessment with the BDA prior to this Workplace Needs Assessment only one set of questionnaires needs to be completed.

Please note that the assessor will also require a brief meeting with the employee's manager either in person on the day of the assessment, or by telephone or email shortly before / after.

General Information

1)Can you provide a very brief description of the individual’s job, the priorities in it and any particular pressure points or key performance criteria?

2)In General Terms, what difficulties do you think the individual’s dyslexia is posing for them at work?

Specific Issues:

Dyslexia generates different strengths and weaknesses for every individual with it. This is partly because it is part of 7 co-occurring conditions and the individual could have traits from any of these. To further inform our professional assessment; please can you indicate where you have observed challenges arising for this individual within the workplace. Here is a list of areas which can be challenging for individuals with dyslexia.

Level of difficulty / Minor / Moderate / Considerable
Memory and Concentration
Following oral instructions
Remembering:
Messages / Appointments
Concentrating for long periods
Visuo – Motor Skills
Inputting data on computer/calculator
Analysing complex visual arrays,
e.g., maps, graphs, tables of figures
Getting bearings in large or complex buildings
Sequencing
Filing
Retrieving files
Looking up entries in dictionaries/directories
Level of difficulty / Minor / Moderate / Considerable
Reading:
Following written instructions
Following technical manuals
Quickly getting the gist of documents
Detailed comprehension at speed
Recalling what has been read
Writing tasks
Spelling
Handwriting
Expressing ideas in writing
Writing memos, emails, letters
Drafting complex material fast
Writing reports
Numerical task
Copying numbers
Tabulating numbers
Doing arithmetic calculations
Following a sequence/procedure
Checking data
Level of difficulty / Minor / Moderate / Considerable
Speech and Comprehension
Following a conversation
Contributing to a discussion
Presenting thoughts succinctly
Organisation
Planning work schedules
Meeting deadlines
Keeping papers in order
Working efficiently

Pre-Assessment Questionnaire for Employee

Thank you for completing this questionnaire. It is very helpful to have feedback on what you find challenging. Everything you include in this response will be treated entirely confidentially and only used for the purpose of forming a more complete picture of the difficulties you experience.

Name
Title / Mr/Mrs/Miss/Dr
Date of Birth
Phone number
Mobile number
Email Address
Job Title
Date started in current role

General Information

1)Can you provide a very brief description of your job role, the priorities in it and any particular pressure points or key performance criteria?

2)In General Terms, what difficulties do you think your dyslexia is posing for you in carrying out your duties?

Specific Issues:

Dyslexia generates different strengths and weaknesses for every individual with it. This is partly because it is part of 7 co-occurring conditions and the individual could have traits from any of these. To further inform our professional assessment; please can you indicate where you have experienced challenges arising within the workplace. Here is a list of areas which can be challenging for individuals with dyslexia.

Checklist of Information Required for Booking:

Completed booking form

Assessment locations – identified the preferred type and location of assessment

Completed questionnaire – Employee & Employer’s

Payment information/payment

Please note we cannot process bookings or book assessments without all of the documentation being complete and payment being received.

Delays in returning documents/sending payment will result in a delay in booking the assessment.

Email this completed booking pack to

British Dyslexia Association, Unit 6a Bracknell Beeches, Old Bracknell Lane, Bracknell, RG12 7BW

Tel: 0333 405 4555 (select Option 2 for the Assessments Department), Email: