1. I know that the Service has plans and assessments about me and I was asked if I wanted to be involved in writing and updating these. I know that I can ask to see all the information that is held about me by the service at any time. *

1

3

5

2. I feel like my views are listened to by staff *

1

3

5

3. Staff have explained Health and Safety to me and I know what to do in an emergency. *

1

3

5

4. I feel safe when I am at this service *

1

3

5

5. I know who to talk to if I don’t feel safe, or if I am worried about myself or a friend. I understand that staff may have to tell someone else so that they can help me. *

1

3

5

6. I know that there are rules that staff have to follow and I know who to report to if they don’t follow the rules. *

1

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5

7. I am able to join in with everything at this service. The staff at the service treat everybody fairly and help us to be the best that we can be. *

1

3

5

8. I feel that the service recognises and supports all of my individual cultural and religious needs. *

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3

5

9. I know that there are rules about behaviour and I know what will happen if I do not stick to these. *

1

3

5

10. I was able to visit the service before joining. I was given a welcome pack or booklet when I first started. *

1

3

5

11. I know who to ask in the service if I need extra support. *

1

3

5

12. All information provided to me by the service is available in the format that I can understand (for example language other than English, braille etc) *

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3

5

13. The service encourages me to improve my skills and make my own decisions (for example making friends and having good relationships) *

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3

5

14. The service supports me to take part in additional activities, such as sports clubs etc. *

1

3

5

15. I know how to make a complaint and who will deal with it, or that someone else can do this on my behalf. *

1

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5

Name *

First Name

Last Name