tenant information questionnaire - easy · 2017. 8. 11. · 2 introduction this is a questionnaire...
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ARK HOUSING ASSOCIATION LTD
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Tenant information questionnaire
Household profile information 2017
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Introduction
This is a questionnaire to find out information about you.
ARK Housing Association would like this information so that they are up date about the tenants living in their homes.
If you stay with other tenants they will get their own questionnaires to fill in.
If you have any questions, please contact Knowledge Partnership on 0800 169 9376.
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About you Question 1. Please write in the boxes:
What is your title? - like Mr, Mrs, Ms
What is your first name
Your surname
Your date of birth
Are you male or female
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Question 2. Please tell us your contact information?
Home telephone number:
Mobile telephone number:
Work telephone number:
E-mail address:
Question 3. How would you like ARK to contact you? (Tick all that apply)
Home phone
Work phone
Letter
Mobile
Other, please say:
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Large Large print
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Question 4. Would you like ARK to use any of these ways to contact you?
Braille
Text phone
Large print
Skilled signer
No additional contact needs
Another language, please say:
Question 5. Would you like ARK staff to do any of these things when they visit you?
Knock loudly
Use back door Use side door
Give me time to answer the door
No special instructions
Other, please say:
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Question 6. What is your ethnic group?
White
Scottish Other British
Gypsy orIrish traveller
Other white Polish background
Mixed Race
Any mixed race
Asian
Pakistani Indian
Bangladeshi Chinese
Other Asian background
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Black
Caribbean African
Other black background
Any other ethnic group
Arab
Other ethnic group
I’d rather not say
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Question 7. Please tell us if you are?
Paid 30hrs or more per week
Paid between 16hrs and 29hrs per week
Paid less than 16hrs per week
Working 30hrs or more per week
Working between 16hrs and 29hrs per week
Working less than 16hrs per week
Training/Apprentice
Unemployed
Retired
At home (not seeking work)
Student
Disabled/Long term illness
Other
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Employed:
Volunteer:
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Question 8. Do you have a disability?
Yes No
Question 9. Please tell us how much you get paid for working each week. (the amount you get before income tax):
£
Question 10. Do you have a bank account for managing your money?
Yes No
Question 11. Does your bank account let you make Direct Debit payments?
Yes No
Don’t know
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Question 12. Do you have household contents insurance?
Yes No
Don’t know
Question 13. Have you used a Foodbank in the last year?
Yes No
Question 14. Would you use a Welfare Advice Service if ARK were to provide this?
Yes No
Don’t know
Question 15. How much do you spend on gas and electricity each month?
£
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Question 16. How do you currently pay for your energy bills?
Monthly direct debit
Quarterly direct debit
Quarterly cash or cheque
Payment card
Prepayment meter
Fuel direct
Other method
Question 17. Have you ever tried to get more value for money from your current energy supplier?
Yes No
Question 18. Have you heard about an energy provider called ‘OUR Power’?
Yes No
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Question 19. Does your home have a Smart Meter?
Yes No
Question 20. Would you like to be involved in helping ARK make decisions? If so how would you like to be involved… (Tick all that apply)
Writing for the ARK newsletter
Being asked about ARK policies
Being part of a group of tenants who comment on ARK’s policies
Joining a tenants’ group
Joining estate walkabouts
Looking at ARK services in depth
Joining the ARK Voices Group
Testing ARK services by phone or visits
None of the above
Other, please say:
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Keeping your information safe ARK Housing Association will look after this information as set out in the law.
This information will be used to:
• Check our services are fair
• Plan new services
• Keep your records up-to-date
• Help us provide a service to your household.
We will keep your information safe and only pass it on if the law says that we must.
Please sign to say that the details given on this form are correct.
Your name
Your signature
Today’s date
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Thursday
31 August
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Thank you
Please check that you have completed all of the questions.
Post this questionnaire and your Tenant Satisfaction Form to Knowledge Partnership in the pre-paid envelope.
You must post it by Thursday 31st August 2017.
All returned survey forms will be entered into a prize draw to win one of three £30 shopping vouchers.
This form will be held separately from your Tenant Satisfaction Survey questionnaire.
Easy read by Easy-Read-Online.co.uk
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