OTD Members | OTD Suppliers

Azor Azor

Purpose of this feedback request...

to assess how Ottawa Therapy Dog (OTD) activities in individual programs meet OTD's standards of practice and the needs of clients. 

The completed form is confidential and will not be shared with the OTD teams.
Home > Resources > Forms > 2010 Facilty Feedback Form

2010 Facility Feedback Form

To be completed by Facility Representative or Contact Person for your OTD Team(s)

Please answer to the best of your ability the questions that are relevant to your experience with each OTD Team for the past 6-12 months. If you would prefer to send your feedback by mail, you can download the Acrobat PDF version of this form

Please respond by May 28th, 2010.

2010 Facility Feedback
Name: * Email: *
Title of person completing this form: Phone Number:
Facility Name: Area/Unit/Floor:
1 What are the benefits for the clients who interact with the therapy dog? Any memorable moments? Please explain:
2 Do you feel that there is open communication between your facility and the OTD administrator/volunteer coordinator?
3 Would you like any additional teams from OTD? No Yes
If yes, please explain:
4 Do you have any general comments, observations or suggestions for Ottawa Therapy Dogs?
5 Would you like OTD to contact you to discuss any issues or concerns? Yes No

*Required to send this online form. You will receive an error message if your name and email is not entered.

 

OTD Team visiting your facility

PLEASE COMPLETE FOR EACH OTTAWA THERAPY DOGS' TEAM(S) VISITING YOUR FACILITY

2010 Facility Feedback OTD Team Form

Name of Dog:
a) Frequency of visit
weekly bi-weekly monthly other (specify)
b) How many clients/patients does the OTD team visit on a regular basis?
c)

Does the handler arrive on the dates scheduled?
Always Most of the time Sometimes Seldom N/A

d)

Does the handler arrive on time?
Always Most of the time Sometimes Seldom N/A

e)

Is the timing of OTD visits?
Just right Too short Too long

f)

Is the handler accompanied by a facility staff member while visiting? Yes No
Or do they visit on their own? or both?

g) Does the dog appear well groomed?
Always Most of the time Sometimes Seldom N/A
h)

Is the handler friendly, presentable, and professional?
Always Most of the time Sometimes Seldom N/A

i)

Does the therapy dog interact well with the clients?
Always Most of the time Sometimes Seldom N/A

j) Has there ever been an incident, issue or concern with the OTD team? e.g. where your Facility's standards of practice were not followed. Yes No
If yes, please summarize:

Thank you for your time!

Ottawa Therapy Dogs
Suite 750
1500 Bank Street
Ottawa, ON K1H 1B8

Should you have any questions, call 613.261.6834 (OTDI) or email us at info@ottawatherapydogs.ca

Home | Site Map | Contact US

© Ottawa Therapy Dogs, 2002-2010
Web site designed by www.guymercier.com

Last Update: May 12, 2010
info@OttawaTherapyDogs.ca

Privacy Policy
Charitable Registration No.: 88312 8308 RR0001