Free Nursing Home Space Utilization Survey Template
Nursing Home Space Utilization Survey
Thank you for taking the time to complete our Space Utilization Survey. Your feedback is essential in helping us improve the use of space within our facility to enhance comfort, safety, and efficiency. Please answer the following questions based on your observations and experiences.
Instructions:
Please fill out the following tables with the required information. If a question is not applicable to you, you may skip it. For questions that require a rating, use the following scale and add a check mark (✔).
1: Very Poor
2: Poor
3: Average
4: Good
5: Excellent
Part 1: General Information
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Question |
Response |
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Your role (Resident, Staff, Visitor) |
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Date of completion |
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Department or area most frequented |
Part 2: Space Allocation
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Question |
1 |
2 |
3 |
4 |
5 |
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How adequate is the space in resident rooms? |
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How adequate is the space in the dining area? |
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How adequate is the space in the recreation areas? |
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How adequate is the space in the hallways? |
Part 3: Facility Amenities
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Question |
1 |
2 |
3 |
4 |
5 |
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Rate the accessibility of common areas. |
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Rate the cleanliness of common areas. |
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Is there sufficient seating in common areas? |
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Are the restrooms adequately accessible and clean? |
Part 4: Safety and Navigation
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Question |
1 |
2 |
3 |
4 |
5 |
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How safe do you feel in the facility’s spaces? |
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Is signage adequate for easy navigation around the facility? |
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Are emergency exits well-marked and accessible? |
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Are there any areas that feel overcrowded or cramped? |
Part 5: Additional Comments
Please provide any additional comments or suggestions that you think would help improve the utilization of space in our facility:
