Survey Monkey Clone Survey Entries Graphs ⬅ You must log into WordPress to use these!!! (or they will take you to a blank page) Survey Monkey Clone 1. Select the month * JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Day MondayTuesdayWednesdayThursdayFridaySaturdaySunday Time 8am9am10am11am12pm1pm2pm3pm4pm5pm6pm 2. Where is the client from * Orillia Oro-Medonte Rama Ramara Severn OtherOther 3. How is the client accessing our service? * Walk-in Email Telephone OtherOther 4. This client was in more than once today * Yes No 5. What type of Service are they accessing? * Information Sharing -phone numbers for businesses, etc Comments, Compliments, and Complaints Referral Service - connecting to an agency Form Filling Assistance Income Tax Intake Email Use Income Tax Inquiries -appt scheduling, questions Phone Use Income Tax Education Mail Use Income Tax Pick-up Printer/Scanning/Copy Use Form Pick-up Housing List Good Food Box OVC Kiosk Good Food Box (Information) OVC -appt scheduling, questions Publications Promotion Drop Off -Posters, Fliers, etc. OESP Clients Cooling/ Warming/ Water Tourism Information Supportive Counselling and advice/socio-emotional support Employment Assistance 6. What is the demographic of the Client? 6. Gender * Male Female OtherOther Age * Youth (12-18) Young Adult (19-34) Adult (35-49) Older Adult (50-63) Senior (64+) Deceased 7. Number of years the client is filing? * 1 2 3 4 5 More (please specify) - does this return reflect household or individual? please detail if there is variation from year to year.More (please specify) - does this return reflect household or individual? please detail if there is variation from year to year. 8. Recipient of Social Assistance? (OW or ODSP/T5007) * Yes No Information unavailable 9. Number of children under the age of 18 living with the client? * 0 1 2 3 4 5 More (please specify)More (please specify) 10. Client's Income Level * Under $15,000 Between $15,000 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and $99,999 Between $100,000 and $150,000 Over $150,000 Submit 6. Which of the following publications did the client access? * Handy Numbers Food Assistance Quick Resources Mental Health Senior Services Moving Checklist Pamphlets Dentist List Doctor List Map Bus Information New Publications (please specify)New Publications (please specify) 7. Which of the following services did the client access? Printing/Copying Scanning/Emailing N/A Other (please specify)Other (please specify) Submit Suggestion * Submit