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Facility Feedback

(Rationale: to gather feedback about OTD activities in individual programs to ensure we continue to maintain OTD’s high standards of practice.)

Name of person completing this form:

Email:

TO BE COMPLETED BY OTD HANDLER
Name of Therapy Dog Handler
Name of Dog
Program (i.e. geriatric ward, Alzheimer’s ward, general,) list if more than one.
How long have you been visiting at this facility?
How often do you visit? (1x week, 1x month, etc.)
Time and length of visits?
Average number of clients seen at each visit?

TO BE COMPLETED BY FACILITY REPRESENTATIVE
Please answer to the best of your ability the questions that are relevant to your arrangements with your Ottawa Therapy Dog handler for the past 12 months.
Date
Name of Facility
Phone number
Does the handler arrive on the dates scheduled? Always Most of the time Sometimes Seldom N/A
Does the handler arrive on time? Always Most of the time Sometimes Seldom N/A
Is the timing of OTD visits? Just right Too short Too long
Is the handler accompanied by a facility staff member while visiting? Always Most of the time Sometimes
Or do they visit on their own? Always Most of the time Sometimes
Does the dog appear well groomed? Always Most of the time Sometimes Seldom Never
Is the handler friendly, presentable, and professional? Always Most of the time Sometimes Seldom Never
Does the therapy dog interact well with the clients? Always Most of the time Sometimes Seldom Never
What are the noticeable benefits for the clients who interact with the therapy dog? Please
explain:
Have there been any incidents where your Facility’s standards of practice were not followed?

No Yes

If yes, please summarize:
What other comments, observations or suggestions do you have?
Would you like us to get in touch with you to discuss any issues or concerns? No Yes
Would you like any additional teams from OTD? No Yes

Comment(s):

 

Thank you from...

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

613.261.6834
admin@ottawatherapydogs.ca

 

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