Check one: Employee _____ Supervisor______
1. Were assigned duties accomplished at the home based station? Yes ____ No____3. What amount of workload was accomplished at home? More____ Less____ Same___
4. Do you feel the program is effective? Yes_____ No_____
5. Has the program motivated you? Yes_____ No_____6. Has the program reduced the stress in you life? Yes___ No____
7. Was your work environment adequate, i.e. computer, telephone? Yes___ No___
8. If the answer to question 7 is no, explain_____________________________________
________________________________________________________________________
_________________________________________________________________________
9. Do you feel the program has improved your quality of life? Yes___ No____
10. Has the program increased your job satisfaction? Yes_____ No_____
11. Did the program have any adverse impact on your office? Yes____ No____
12. If the answer to question 11 is yes, please explain.
_____________________________________________________________________
______________________________________________________________________
13. Would you like to see the program continue? Yes _____ No ____
03/15/10
