The HSA Group comprises:
Specialists in workplace
Client
health and medical services
Health assessments, from
Feedback Form
recruitment to retirement
We welcome your
Absence management and comments on our service
employee wellness
Experts in workplace safety Understanding your needs and our own performance
and rehabilitation is important to us. Because of this, we value any
Job capacity assessment and feedback you can give us. Whether you have had a
return to work great experience, or feel that we could have done things
Organisational psychology and better, we would love to hear from you. Simply fill in this
employee wellbeing and health form and leave it in the box at reception, or post it back
BRISBANE QLD 4001
to us.
Your feedback is invaluable in assisting us to continually
Service and Quality
Specialists in travel advice
and vaccinations improve our services.
Reply Paid 9821
Anti-malarials and specially Yours sincerely
designed travel medical kits
HSA Group
Proud to be an Official Supplier
to the ARU and the Wallabies
Andy Gates
Executive General Manager
© HSA Group 2007
www.worksolutions.com.au

Service was delivered to: Our Service Further Information
How strongly do you agree or disagree with the following (please tick appropriate box)
_________________________________________
statements.
strongly agree strongly disagree I would like more information from Work Solutions
Which of our offices provided
regarding the following services:
your service? Where required the consultant
explained their role to you clearly
5 4 3 2 1 n/a
Occupational safety and injury prevention
_________________________________________ The information provided to you Occupational rehabilitation and redeployment
during the meeting / consultation
Type of service provided met your expectations and was
5 4 3 2 1 n/a Consulting and training
(please tick appropriate box) relevant Psychological services and counselling
The quality of service provided Corporate wellness and health
Occupational Health & Safety Services by the consultant met your 5 4 3 2 1 n/a Functional assessments
expectations Recruitment selection
Occupational Rehabilitation Services
In your opinion the service met Ergonomic assessments and task analysis
Consulting & Training Services and addressed appropriate privacy 5 4 3 2 1 n/a
Employment Placement Services requirements
Additional comments
Psychological Services You were consulted and had
moisten here
sufficient input into the services 5 4 3 2 1 n/a Is there a staff member or process worthy of special
Corporate Wellness provided mention?
Physical Assessment Services The overall outcome was timely 5 4 3 2 1 n/a _________________________________________
Recruitment Selection
You were satisfied with the _________________________________________
5 4 3 2 1 n/a
outcome of the services provided
How to complete this form Communication was regular, timely Please provide any further feedback that might help
5 4 3 2 1 n/a
Please circle the number that indicates your level of and informative us improve our service
satisfaction or agreement The overall outcome was _________________________________________
5 4 3 2 1 n/a
cost effective
_________________________________________
Our People
How strongly do you agree or disagree with the following
Satisfaction Please contact me regarding
statements.
strongly agree strongly disagree How satisfied were you with... my comments
very satisfied very dissatisfied
The consultant was professional
5 4 3 2 1 n/a Your overall experience Yes No
and courteous 10 9 8 7 6 5 4 3 2 1
The consultant demonstrated an The outcome of your Name ___________________________________
5 4 3 2 1 n/a
understanding of your needs involvement with Work 10 9 8 7 6 5 4 3 2 1 Company _________________________________
Solutions
The consultant was responsive to Postal address _____________________________
5 4 3 2 1 n/a
enquiries at all times
_________________________________________
Phone ___________________________________
Email ___________________________________
www.worksolutions.com.au