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Disability Equality Scheme - Feedback Form

Scottish Water are working on the principles of our Disability Equality Scheme and are looking for your assistance. Please take a few moments to complete this form, it will help us understand your issues and priorities for service delivery. Please place a cross in the relevant boxes or write your answers in the spaces provided. Once completed please return by email to molly.finnegan@scottishwater.co.uk or fax or post a hard copy to the details below.

Normal Service Delivery
Think about the everyday service you receive from Scottish Water.
Q1. How satisfied are you with the service provided by Scottish Water?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Don't Know
Q2. What are the reasons for your answer?
Q3. What improvements could be made to the service provided by Scottish Water?
Q4. How satisfied are you that Scottish Water provides appropriate services to customers with an impairment?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Don't Know
Q5. What improvements could be made to the services provided to customers with an impairment?
Planned Work
Think about when Scottish Water may have to conduct planned work on our network.
Q6. Have you ever experienced planned work?
Yes (Go to Q7)
No (Go to Q9)
Q7. How satisfied were you that this work was carried out sensitively to your needs?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Don't Know
Q8. What improvements could be made?
Q9. What would be your requirements when Scottish Water carry out planned work?
Emergency Incident
Think about a situation where your normal water supply is not available at short notice.
Q10. Have you ever experienced an emergency incident?
Yes (Go to Q11)
No (Go to Q17)
Q11. Please give a brief description of this incident, including location:
Q12. How satisfied are you that your needs were met during this incident?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Don't Know
Q13. What improvements could be made?
Q14. Did you contact Scottish Water during this incident?
Yes (Go to Q15)
No (Go to Q17)
Q15. How satisfied are you with the response you received from Scottish Water?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Don't Know
Q16. What improvements could be made to the response you received?
Q17. What would be your requirements during an emergency incident?
Q18. Are you on an Emergency Consideration Register (Special Services Register) ? (please tick all that apply)
Yes, Scottish Water's Register
Yes, Council's Register
Yes, other Register
No
Q19. What is the nature of your disability?
Sensory
Mobility
Learning
Illness or Disorder

Other, Please Specify:
Q20. Are you?
Male
Female
Q21. What age are you?
16-24
25-34
35-44
45-54
55-64
65+
Further Assistance
In order to ensure our Disability Equality Scheme is developed in accordance with the needs of our customers, we may need to discuss some elements in more depth. This is likely to take the form of a short telephone interview.
Q22. Would you be willing to help us further in the creation of our Scheme?
Yes (Please Complete the Details Below)
No (Thank you for your time, please scroll down and select the 'Submit' below)
Q23. Name

 
Q24. Address
Q25. Telephone Number

 
Q26. Email

 
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