Exit this survey Formal Referral Follow Up Questions Question Title * 1. The EAP management referral process was helpful in my job as a supervisor/manager. Strongly Disagree Disagree Neutral Agree Strongly Agree Question Title * 2. Given the limits of confidentiality, the EAP case manager provided me with on-going feedback regarding this employee's participation and compliance. Strongly Disagree Disagree Neutral Agree Strongly Agree Question Title * 3. The EAP supervisor referral process was an efficient and straightforward process. Strongly Disagree Disagree Neutral Agree Strongly Agree Question Title * 4. Is this person still employed by your organization? No Yes Question Title * 5. Reason for referral. Check all that apply. Job Performance Problems Substance Abuse Problems Behavioral Concerns Violence Issues Question Title * 6. Are there any additional comments you wish to make? Question Title * 7. Please list your name (Referring supervisor) Question Title * 8. Please list the name of your company. Question Title * 9. Please select the name of the clinician that worked with you. Barbara Givens Becky Tomaszewski Cassi Hensley Evelyn Ellis Hamp Hinkle John Trombello Kim Dupuis Mary Kay Berhalter Tiffany Huggins Question Title * 10. Case Number, Employee's Last Name Submit