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Baseline Assessment (Within First Week)

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Uploaded by: Makerble Templates
Number the questions (only when viewed internally)

Section 1: Basic Needs

Q1. Safe Accommodation Provided (single choice)

Question Settings ▼ ▲

Did you have a safe place to sleep last night?

Yes No

Dropdown List used: Safe Accommodation Provided

Q2. Food Security (single choice)

Question Settings ▼ ▲

Have you had enough to eat today?

Yes No

Dropdown List used: Food Security

Q3. Hygiene Facilities Access (single choice)

Question Settings ▼ ▲

Have you been able to wash and access clean clothes?

Yes No

Dropdown List used: Hygiene Facilities Access

Q4. Felt Safe (single choice)

Question Settings ▼ ▲

How safe have you felt while staying here?

1.Very unsafe 2 3 4 5.Very safe

Dropdown List used: Felt Safe

Section 2: Health & Wellbeing (Scale 1-10)

Q5. Physical Health Perception (single choice)

Question Settings ▼ ▲

How would you rate your physical health right now?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Physical Health Perception

Q6. Mental Health & Wellbeing (single choice)

Question Settings ▼ ▲

How would you rate your mental health and wellbeing right now?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Physical Health Perception

Q7. Hope for the Future (single choice)

Question Settings ▼ ▲

How hopeful do you feel about your future?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Physical Health Perception

Section 3: Current Situation

Q8. Current Situation (single choice)

Question Settings ▼ ▲

Are you currently in any form of treatment or support for substance use?

Yes No

Dropdown List used: Current Situation

Q9. Health Services Accessed (single choice)

Question Settings ▼ ▲

Which health services have you accessed while here?

GP Dentist Mental health services Substance use services Hospital/A&E Sexual health None

Dropdown List used: Health Services Accessed

Collect survey responses

360°
360°
Invite observers to answer a survey about a contact in your CRM. Send out invitations for several contacts at once via email, SMS or your own channels.

Collect Responses

Universal
Universal
Allow anyone with the link to submit a survey response.
Optionally generate a QR code.
Share Link

Tracked
Tracked
Track responses to individual contacts. Send survey invitations via email and SMS - with automated reminders - or your own communication channels.
Collect Responses

Anonymised
Anonymised
Hide the identity of each respondent when collecting responses from saved contacts or a list of email addresses.
Collect Responses

Import
Import
Upload survey responses from a spreadsheet with a row per respondent and column per question.
Import Responses

API
API
Send out survey invitations programmatically and/or receive responses via the API..
Get Started

Filled in by a Colleague: 1 contact at a time
Filled in by a Colleague: 1 contact at a time
Submit a survey response about a saved contact while filling in a survey in-person (CAPI), over the phone (CATI) or typing up a paper survey response.
Collect Response

Filled in by a Colleague: Several at once
Filled in by a Colleague: Several at once
Use the Answers Table to submit responses to each question. There’s one row per contact. Responses are automatically linked to individual contacts.
Enter Responses

Filled in by a Colleague: Manual Headcount
Filled in by a Colleague: Manual Headcount
Enter responses without the need for individual contacts or respondents. Enter the number of people who gave each answer to each question.
Enter Quantities

Universal Manual Headcount
Universal Manual Headcount
Collect manual headcount responses from anyone with the link.

Share Link

Multi-stage
Multi-stage
Collect demographic data. Thread several surveys together. Deliver advanced survey experiences.
Go to Signup Pages

Branded Portal
Branded Portal
Provide respondents with a password-protected space to submit, review, discuss or act upon survey responses.
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Automation
Automation
Automatically send out survey invitations whenever certain rules are met
Create an automation

360° Assessment
360° Assessment
Get a rounded view of each contact by combining their self-reflections (Tracked), perspectives from people who know them (Observers) and your colleagues' professional opinions (Filled in by a Colleague). Send invitations for several contacts at once by email, SMS or your own channels.

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