Residential Staff Feedback Form
Staff Use Only
Residential Start Date
Residential End Date
Brief overview of child's abilities.
You must provide an answer for each row.
To what extent was the child able to complete the following tasks?
Prompts & Reminders
Unpack & organise their things
Make their own bed
Chose their own food
Carry plate to and from the table
Clear up after meals
Set table for meals
Cut own food
Pour a drink
Put on / fasten shoes
Put on / fasten coat
Brush their teeth
Clean themselves at the toilet
Choose clothes to wear
Participate in activities
Make choices from gift shop
Use money appropriately
Settle themselves to sleep
Socialise with others
Complete evaluation form
Detailed overview of child's abilities.
Please answer these to the best of your ability. The information provided here is used as evidence to our funders.
Overall assessment of child's abilities, comparisons can be made to previous residentials if appropriate .
Comments made by child during the residential break.
Has the child presented with any behaviours that have challenged you, or could be perceived by others as difficult to manage?
Have you had to use any physical intervention for the child named on this evaluation form, during the residential?
If you answered yes to either of the above questions, please provide further details on any incidents.
Please rate your experience as a member of staff on this residential:
We are always looking at ways to improve the experience for staff and children. If you have any comments or ideas about how we can do this, please use the space below to let us know:
Thank you for completing the staff evaluation. We look forward to seeing you again soon :)
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