Crofton Impacted Employee Survey

Workers' Needs Assessment Confidentiality Agreement

Personal information collected in the Workers’ Needs Assessment survey is collected under the authority of section 26 (c) of the Freedom of Information and Protection of Privacy Act and is subject to all the provisions of that Act. The personal information collected will be used by the ETHOS Career Management Group Ltd. and disclosed to the Ministry of Social Development and Poverty Reduction, its service providers, and associates of its service providers to administer a Workers’ Needs Assessment and produce a final report based on the information. If you have any questions about the collection and use of this information, please contact ETHOS Career Management Group Ltd. at contact@ethoscmg.com.

As part of your participation in the Workers’ Needs Assessment Survey, personal information will be collected from you, including, but not limited to, your name, contact information, and demographic information. All identifiable information will be kept confidential and excluded from the final report. Survey responses will be compiled and anonymized for the purposes of the Workers’ Needs Assessment final report.

By signing or clicking the "I Agree" box below, I agree that: Effective as of the date set out below, and in consideration of the opportunity for me to participate in the Worker Needs Survey, I agree that ETHOS Career Management Group Ltd. may need to collect, use, and disclose my information for the following purposes:

to conduct follow-up interviews regarding the information provided in the Worker Needs Survey,
to provide support services to me,
to produce a final report that will be distributed to the community, and its support partners. These groups will be responsible for determining the appropriate response(s) to this report.

Furthermore, I

understand that providing personal information including my name, email address, and phone number is voluntary and not mandatory to complete the Workers’ Needs Survey
consent to the collection (including indirect collection), disclosure, and use of my Personal Information by ETHOS Career Management Group Ltd., for the purposes described above;
consent to my Personal Information being used to contact me to conduct follow-up interviews.

By clicking the box below, you understand and agree to the Confidentiality Agreement outlined above.(Required)

I agree.

Signature

Signature of Client/Guardian or Legal Representative

Name

First Last

Date

If signing on behalf of the client, specify relationship

Contact Phone Number

Please take this 5-minute survey to help us understand how to support you in future employment opportunities. Your responses will be compiled with any others to produce a final report that will inform the community of the help that’s needed for impacted workers and their families. All information provided will be kept confidential and your name will not be linked to your answers in the final report.

Demographics

What is your Age?

Do you identify as any of the following groups? (Select all that apply):

Employment Status

Current employment status

Full-time

Part-time

On-call or Auxiliary

Have you recieved a lay-off notice?

Yes

What is your estimated date for separation from employment?

Do you anticipate recieving a lay-off notice?

Yes

Education and Certification

What is your current level of education?

Less than Grade 10

Some High School (Grade 10 - 12)

Grade 12, GED, Adult Graduation Diploma, or equivalent

Some Post-Secondary

Post-Secondary Degree or Diploma

Education or training outside of Canada

Apprenticeship or trade certificate or diploma

Current year of Apprenticeship:

List any certifications that you currently hold:

Equipment Operation

Current Driver's Certification:

Class 5

Class 4

Class 3

Class 2

Class 1

Air Endorsement

Other Driver Certification

Please enter your other Driver's Certifications here:

Identify any equiptment you are trained on or certified to operate (check all that apply, and/or include additional experience not listed.)

Backhoe

Boom Lift

Bucket Loader

Bulldozer

Chipper

Crane

Excavator

Farm Equiptment

Forklift

Grader

Grapple

Hiab

Loader

Lumber Grader/Trimmer

Lumber Stacker

Zoom Boom

Mini Excavator

Skid Steer

Skidder

Tilt Hoist/Planer Feeder

Transfer Truck

UTV/ATV

Water Truck

Yarder

List other equipment training or certification not listed above here:

Barriers to Employment

Do you identify as having barriers which may impact your search for new employment?

Yes

Please Check all Barriers that apply:

Please enter your other barriers here:

What is your level of competency operation computers and/or using the internet?

Advanced (have training and skill level beyond day-to-day use)

High (have experience; very comfortable using computers, different computer software, and the internet)

Medium (have some experience; somewhat comfortable using computers and the internet)

Low (have little or no experience; not comfortable using computers and/or the internet)

Employment Locales

Are you willing to relocate?

Yes

Are you willing to work in a camp?

Yes

Future Employment - Self and Partner

Are you willing to leave the pulp and paper industry to pursue other employment options?

Yes

Do you have any employment experience outside the pulp and paper industry?

Yes

In what business sector(s)?

In which industr(y/ies) would you be interested in looking for a future job? (select all that apply)

Please specify which other industries you're interested in here:

Do you have an interest in self-employment?

Yes

How confident are you that you will find new employment/become self-employed?

1 - Not confident at all

3 - Somewhat confident

5 - Very confident

Not sure

Do you have a spouse or common-law partner that is considering returning to the workforce in response to employment uncertainty?

Yes

In which industr(y/ies) would they be interested in looking for a future job? (select all that apply)

Please specify which other industries they're interested in here:

Do they identify as having barriers which may impact their search for new employment?

Yes

Please Check all Barriers that apply:

Please enter their other barriers here:

Personal and Family Impacts

What level of personal stress are you experiencing from employment uncertainty?

The Stress from employment uncertainty is impacting your:

Relationships

Physical well-being

Mental Health

Financial Security

Housing Security

Pre-existing Health Condition

Other

Please enter what other aspects the stress of employment uncertainty are impacting here:

What level of stress is your family experiencing from employment uncertainty?

The Stress from employment uncertainty is impacting your family in these ways:

Relationships

Physical well-being

Mental Health

Financial Security

Housing Security

Pre-existing Health Condition

Other

Please enter what other aspects the stress of employment uncertainty are impacting here:

Supports Needed

I would find these supports helpful at this time (check all that apply):

Individual Counselling

Counselling for Family Members

Couples Counselling

Stress Management Groups

Transition Planning Program

Group Support with Colleagues

Addictions Supports

Choose the best description of your social supports (having friends, family, and other people to turn to in times of need):

I feel like I have enough support to get me through this adjustment

I have some social support to help me with this adjustment

I have professional support to help me with this adjustment

I am lacking in social support

Choose the best description of your community suppports:

I have access to all the support I need within my community for adjustment

I have some community-based supports and knowledge of supports to access

I have limited community-based supports and knowledge of supports available to me

I have no community-based supports or knowledge of supports available to me

Do you have any specific needs or required supports you would like to share with us?

OPTIONAL - If you would like us to follow up directly with you, please provide your name and contact information.

Name

First Last

Phone