Thank you for using Converge International's Critical Incident Management and Response service. We trust that you found the service effective and compassionate. We are committed to providing services of the highest quality. We would greatly appreciate it if you would take just a couple of minutes to complete this short questionnaire about your experience with Converge International. Of course, all responses are completely confidential.

Please complete the following questions relating to your satisfaction with the services provided.

Strongly Disagree Neutral Strongly Agree The person who received my initial contact was professional and compassionate The critical incident coordinator responded promptly A counsellor responded to the critical incident promptly The critical incident coordinator was professional and knowledgeable The counsellor/s understood the issues facing our company The counsellor/s was understanding and compassionate toward our employees The critical incident response met our organisational requirements Timely feedback and/or reports were provided to management Overall, I was satisfied with Converge International's critical incident response

Your organisation

Your name

Converge International CI Coordinator (if known)

Converge International Counsellor/s (if known)

Incident date

Job Number (if known)

Time taken for CI Coordinator response (minutes)

Time taken for Converge International presence onsite (hours)

How could our services be improved?

Any additional comments?

Please indicate whether you consent to Converge International using your comments in promotional material.

I give permission for my comments to be used in promotional material, and to be attributed to my organisation (but not myself) I give permission for my comments to be used in promotional material only if myself and my company are not disclosed I do not give permission for my comments to be used in promotional material