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 23 questions, most of them short yes, sometimes, or no grids, across five pages.
What this survey measures
Residents answer short, plain questions with Yes, Sometimes, or No across the areas that shape daily life: staff and care, personal care and health, their room and the home, wellbeing, peace and quiet, meals and dining, activities, everyday choices, visitors and family, keeping informed, and health and other services. A short moving in section uses Yes, No, or Not sure. Simple Poor to Excellent ratings cover each staff group, the facilities, and each meal. An overall satisfaction rating and a recommendation score give you numbers to track over time, and two comment boxes let residents say what they value and what they would change.
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 circle 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.