I.
|
Identification
|
1. |
Date: Age: Gender: Municipality: |
2. |
Position: ( ) Speech language pathologist ( ) Otorhinolaryngologist ( ) Social worker ( ) Manager ( ) Coordinator ( ) Others |
3. |
Background: ( ) Incomplete Primary Education ( ) Complete Primary Education ( ) Incomplete Secondary Education ( ) Complete Secondary Education ( ) Incomplete Higher Education ( ) Complete Higher Education ( ) Post-graduation. Please specify: ( ) Specialization in Public Health ( ) Specialization in another area. Please specify: ( ) MSc. ( ) PhD. |
4. |
Have you previously worked in the public service? ( ) Yes ( ) No If yes, mention the latter institution and position/function: |
5. |
Length of service in the current management: |
6. |
Employment relationship (mark only one answer): ( ) Submitted to a public contest (effective) ( ) Contract ( ) Third party ( ) Others |
7. |
Salary range: ( ) < R$ 545,00 ( ) From R$ 546,00 to R$ 1.090,00 ( ) From R$ 1.091,00 to R$ 2.180,00 ( ) From R$ 2.181,00 to R$ 4.360,00 ( ) Greater than R$ 4.361,00 |
II.
|
Data related to the care / service profile
|
1.
|
Care/activity routine:
|
1.1 |
Reception of patients: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.2 |
Patient scheduling ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.3 |
Screening/simplified consultation: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.4 |
Full audiological evaluation: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.5 |
Audiological diagnosis: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.6 |
Adaptation and selection of hearing aid: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.7 |
Individual therapy: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.8 |
Group therapy: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.9 |
Referral of patients: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.
|
Actions of the service in which is inserted:
|
2.1 |
Health promotion actions: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.2 |
Interlocution with the school for guidance: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.3 |
Referral to medium complexity services: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.4 |
Referral to high complexity services: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.5 |
Interlocution with SCFH/FHT: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
3.
|
Scheduling
|
3.1 |
Realized by means of: ( ) Spontaneous demand ( ) Scheduling center ( ) Personally ( ) Telephone ( ) Referral ( ) Others |
4. |
Reference service(s) (to where their patients are referred): |
III.
|
Data of the assisted population
|
1.
|
Population
|
1.1 |
Predominant age group: ( ) infants ( ) pre-school ( ) school ( ) adolescents ( ) adults ( ) elderly ( ) don’t know ( ) does not apply |
1.2 |
Place of residence: ( ) in the municipality ( ) other municipalities ( ) countryside ( ) don’t know |
IV.
|
Team
|
1. |
Team composition: ( ) Speech language pathologist ( ) Psychologist ( ) Otorhinolaryngologist ( ) Social worker ( ) Educator ( ) Secretary ( ) Administrative assistant ( ) Others Which? |
2.
|
Team meetings:
|
2.1 |
Discussion of clinical cases: ( ) Yes ( ) No Frequency: |
2.2 |
Action planning: ( ) Yes ( ) No Frequency: |
2.3 |
Administrative demands: ( ) Yes ( ) No Frequency: |
2.4 |
Training/update: ( ) Yes ( ) No Frequency: |
2.5 |
Discussion of results achieved (evaluation): ( ) Yes ( ) No Frequency: |
2.6 |
Others (mention which): ( ) Yes ( ) Does not apply Frequency: |
V.
|
Your role/profile
|
1.
|
Are part of your work routine:
|
1.1 |
Realization of examinations: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.2 |
Reception of patients: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.3 |
Patient scheduling: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.4 |
Issuance of technical reports: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.5 |
Completion of forms: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.6 |
Scientific research: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.7 |
Construction/feeding of data base: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.8 |
Team meetings: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
1.9 |
Organization of the agenda: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.
|
Scientific production:
|
2.1 |
National congresses: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.2 |
Regional seminars/symposia: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
2.3 |
Production of scientific works/articles: ( ) Never ( ) Rarely ( ) Sometimes ( ) Always |
VI.
|
Your satisfaction with
|
1.
|
Structure of the service:
|
1.1 |
Physical space: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
1.2 |
Diagnostic equipment: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
1.3 |
Equipment maintenance: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
1.4 |
Accessibility: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
2.
|
Human resources:
|
2.1 |
Wage policy: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
2.2 |
Human resources policy: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
2.3 |
Perspective of actuation: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
2.4 |
Team profile: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
3.
|
Care/routine:
|
3.1 |
Assisted population (profile): ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
3.2 |
Agenda: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
3.3 |
Work routine: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
3.4 |
Developed activities: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
VII.
|
Communication and work
|
1.
|
Think about the way of communication in your workplace, considering the relationships with other team members:
|
1.1
|
Your communication in your work is: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
1.2
|
In your work, the communicative relations: ( ) little harm ( ) indifferent ( ) help ( ) help a lot |
1.1
|
Your communication in your work is: ( ) very unsatisfactory ( ) unsatisfactory ( ) indifferent ( ) satisfactory ( ) very satisfactory |
1.2
|
In your work, the communicative relations: ( ) little harm ( ) indifferent ( ) help ( ) help a lot |