This care home resident satisfaction survey gives residents a simple, large-print way to share how they feel about daily life in the home. It is designed for aged care and retirement homes that want direct, dignified feedback from the people they support. The template has 7 rating grids across the main areas of care and fits on roughly two to three pages.
What this survey measures
Residents respond on a five point agree to disagree scale across seven themes: communication and care from staff, the room and home environment, dining and meals, activities on offer, the admission experience, how noise affects them, and the everyday choices they can make. Each theme uses short, plain questions such as whether staff treat them with respect, whether the food is served at the right temperature, and whether they can go to bed when they like.
How to use it on paper
Print the survey and hand it to residents at their own pace, or offer it during a keyworker visit or family meeting so someone can help if needed. Ask residents to use a blue or black pen and mark one box per row. Collect the completed forms in a sealed box to protect privacy, then scan them with PaperSurvey to turn every marked box into results automatically, with no manual data entry.
Customize this template
You can add your home's logo, adjust the scale wording, reword any question to match your care standards, and add or remove whole sections. The layout reflows automatically as you edit, so grids and pages always stay aligned.
Preview the PDF above, or use this template to start collecting responses today.