Senior Citizen's Guide to Philadelphia and Suburbs Fall/Winter 2013 - page 14

12
Say You Saw It in the Senior Citizen’s Guide to Philadelphia & Suburbs
Adult Day Service Program
SITE VISIT CHECKLIST
Make a separate sheet for each Center you call and
fill out the information on top before you go. Also take
time to write down your first impression both from your
phone contact and your visit. This information will help
you sort out your thoughts.
Name of Center:_ _______________________________
Phone:_____________Contact Person:_ _____________
Address (Directions):_ ___________________________
_____________________________________________
Visit date / time:________________________________
Things to bring to visit:___________________________
Yes No I felt welcomed.
Yes No Staff made my loved one feel welcome.
Yes No Staff spent time finding out what I want
and need.
Yes No Staff clearly explained what services and
activities the center provides.
Yes No Staff asked important questions about my
loved one.
Yes No Staff presented information about the program
activities, staff and costs.
Yes No The building and the rooms wheelchair
accessible.
Yes No There was sturdy, comfortable furniture,
Loungers and chairs with arms.
Yes No Staff and participants were engaged in
group activity
Yes No Staff and participants were interacting and
seemed happy.
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