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Uploaded by: Makerble Templates

Section 1: Exit Details (Staff-recorded)

Q2. Move-on Destination (single choice)

Question Settings ▼ ▲

Where did the person move to upon exit?

Supported housing/hostel Private rented accommodation Social housing Staying with family/friends Residential treatment/rehabilitation Hospital/care facility Prison/custody Another emergency accommodation service Returned to rough sleeping Unknown/lost contact Other

Dropdown List used: Move-on Destination

Q3. Planned vs Unplanned Exit (single choice)

Question Settings ▼ ▲

Was this a planned move-on or unplanned exit?

Planned Unplanned

Dropdown List used: Planned vs Unplanned Exit

Q4. Accommodation Secured Before Exit (single choice)

Question Settings ▼ ▲

Was accommodation secured before the person left?

Yes No

Dropdown List used: Accommodation Secured Before Exit

Q5. Length of Stay

Question Settings ▼ ▲

Total Nights Stayed



Q6. Ongoing Support in Place (single choice)

Question Settings ▼ ▲

Does the person have ongoing support arranged for after they leave?

Yes No

Dropdown List used: Ongoing Support in Place

Q7. Type of Ongoing Support (single choice)

Question Settings ▼ ▲
Housing support worker Mental health services Substance use treatment Healthcare Benefits/financial support Employment support None Other

Dropdown List used: Type of Ongoing Support

Q8. Key Worker Assigned (single choice)

Question Settings ▼ ▲

Does the person have a named key worker for ongoing support?

Yes No

Dropdown List used: Key Worker Assigned

Section 2: Assessment & Planning (Staff-rated)

Q10. Which health services did you access while here? (single choice)

Question Settings ▼ ▲

Which health services did you access while here?

GP Dentist Mental health Substance use Hospital Sexual health None

Dropdown List used: Which health services did you access while here?

Q11. Did you start a benefits application? (single choice)

Question Settings ▼ ▲

Did you start a benefits application?

Yes No

Dropdown List used: Did you start a benefits application?

Q12. Do you now have photo ID or essential documents? (single choice)

Question Settings ▼ ▲

Do you now have photo ID or essential documents?

Yes No

Dropdown List used: Do you now have photo ID or essential documents?

Section 4: Confidence & Wellbeing (Resident self-report if possible - Scale 1-10)

Q14. Housing Confidence (single choice)

Question Settings ▼ ▲

How confident do you feel about your housing situation going forward?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Housing Confidence

Q15. Ability to Sustain Accommodation (single choice)

Question Settings ▼ ▲

How confident do you feel in your ability to keep your accommodation?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Housing Confidence

Q16. Knowledge of Housing Rights (single choice)

Question Settings ▼ ▲

How well do you understand your housing rights and options?

1 2 3 4 5 6 7 8 9 10

Dropdown List used: Knowledge of Housing Rights

Q17. 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

Q18. Mental 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

Q19. Overall, how would you rate your experience staying here? (single choice)

Question Settings ▼ ▲

Overall, how would you rate your experience staying here?

1 2 3 4 5

Dropdown List used: Overall, how would you rate your experience staying here?

Q20. Did you feel supported by staff? (single choice)

Question Settings ▼ ▲

Did you feel supported by staff?

1 2 3 4 5

Dropdown List used: Did you feel supported by staff?

Q21. What was most helpful during your stay? (Text)
This question will appear once within your story or survey response.

Q22. What could we improve? (Text)
This question will appear once within your story or survey response.

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