Firesetter evaluation form – Referrer
We hope that you and the young person you referred to us found the time with our staff informative and engaging. We are always looking to improve and build on the sessions we deliver; as such your feedback is vital in this process. I would be grateful if you could complete this feedback form.
1. Your name
2. Name and age of young person
3. Relationship to person referred.
4. On a scale of 1 – 10 with 1 being low and 10 being high how helpful did you find our work with the young person.
-- Select --
1
2
3
4
5
6
7
8
9
10
5. Were you satisfied with the outcome?
-- Select --
Yes
No
6. Based on the above what did you find the most and least useful?
7. In your opinion what do you believe the young person learnt from the work?.
Increased awareness of consequences of fire setting
Understand how quickly fire spreads
Understand the dangers of fire setting to themselves and others
Inspire them to avoid further fire setting behaviour
8. Can you tell us anything the young person has been doing differently as a result of our work?
9. Is there anything you will do differently with the young person as a result of our work?
10. Is there anything else you would suggest we could do to support you and your young person?
11. We would like to speak to you again in about 3 months time to go through your responses above and see how things are for you and the young person, would this be ok?
-- Select --
Yes
No