Supervisory Consultation (e.g., help in referring an employee)

Organizational Consultation

Critical Incident Stress Debriefing (following a traumatic event)

Other:

Name of COPE Counselor/Consultant with whom you spoke:

1. My initial inquiry was handled promptly:

1	2	3	4	5	6	7
Strongly Disagree						Strongly Agree

2. The EAP Counselor with whom I spoke readily understood the problem/issue I presented:

1	2	3	4	5	6	7
Strongly Disagree						Strongly Agree

3. The EAP Counselor helped me determine the best course of action to resolve the problem:

1	2	3	4	5	6	7
Strongly Disagree						Strongly Agree

4.The Counselor helped me implement the chosen action plan:

1	2	3	4	5	6	7
Strongly Disagree						Strongly Agree

5.The Counselor followed up with me to ensure that the action plan was successful:

1	2	3	4	5	6	7
Strongly Disagree						Strongly Agree

6. Overall, my satisfaction with my EAP consultation is:

1	2	3	4	5	6	7
Very Low						Very High

7. I would utilize the EAP again:

1	2	3	4	5	6	7
Definitely No						Definitely Yes

8. I would recommend use of the EAP to my colleagues:

1	2	3	4	5	6	7
Definitely No						Definitely Yes

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