Full Survey Template

This template provides a set of example questions. These can be adapted, deleted or used in full. We have provided an explanation of the rationale for each question on the left, (i.e. why you might choose to include it) and some examples of possible questions on the right of the document. Other questions can be used to replace the example questions provided. Services/organisations should customise their own data collection template to suit their context and needs.

While the template is in survey format, it can be adapted for any mode including phone or face to face interview, as well as an online survey instrument. This set of survey questions is designed for adults. Alternate data collection questions and methods should be used for children.

We note that users of community services that we have consulted have stated their preference for qualitative data collection that enables a conversation about outcomes and related topics.

To make life easier, there is a form on this page that you can use to auto-fill fields in the template that are relevant to your organisation.

If you would prefer a version without filled-in fields, you can download it by clicking on this link.