• Customer Feedback For

  • Conducted on

  • Staff Member


  • What services have you provided with this customer?

  • What activities have you been doing in the last 2 weeks?

  • What meals has customer been cooking?

  • Have you been able to complete all your duties?

  • Have there been any noticeable changes with the customers behaviour/mood in the last 2 weeks?

  • What activities of daily living has the customer been involved in?

  • Has there been any issue that you have witnessed in the last 2 weeks?

  • Are there any WHS issues?

  • Any further comments.

  • Report signed by:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.