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Homeless Survey Form

Daniel Harris: Housing and Homelessness Advocate Brighton > Homeless Survey Form

Take The homeless survey if you have been placed by brighton and hove city council

Whether you are one of my personal housing and homeless clients or not. I strongly recommend you take the time to complete the following Homeless Survey. 

About You

YOUR HOME

ISSUES

If so please state who and what has or hasn't happened?

How would you rate Brighton and Hove City Council for the following

*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied
*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied
*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied

How would Rate Your Current Homeless Accommodation and Landlord

*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied
*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied
*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied
*= Very Unsatisfied, **= Unsatisfied, ***= Neutral, ****= Satisfied, *****= Very Satisfied

Outcomes

Weekly

Health, Wellbeing and Belonging

These questions are on a scale of 1= never, 2= not very often, 3= not often, 5= sometimes, 7= often, 8= very often, 9= most days, 10= all the time and so on. Please answer these honestly.

Equality

Thank you for for completing this survey. I will keep you informed on the reports of these client surveys

General Data Protection Regulations (GDPR) & Data Protection

Dear Client,

Due to GDPR and Data Protection Legal Requirements around Authority and Consent Forms, Third parties, such as local councils require full written consent to comply with any advocacy casework requests.

The purpose of this form is to obtain:

  1. written confirmation that you want a third party (Myself) to represent you during the investigation into your homeless related complaint / issue or Social Injustice; and
  2. consent for me to share your personal information obtained during the investigation with relevant parities.
  3. this can include but is not exclusive; Subject Access Requests on your behalf, the information will normally be sent to you, unless you state otherwise, these can also include statutory appeals & signposting.
  4. Your right to withdraw consent: Please note that you have the right to withdraw either consent at any time; just let me know. By emailing [email protected]
This form should only be signed if you want the person named below ("your representative") to act for you in respect of your advocacy, complaint and/or social injustice issue.
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New clients must complete the registration and permission form and I recommend you also complete the Homeless Survey
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