10-1500196(WS) DMC Survey

Data Monitoring Committee (DMC) Survey

OMB No. 2900-0770
Estimated Burden: 5 minutes

Expiration Date: 08/31/2017

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VA Form 10-1500196(WS)
NOV 2015

Instructions: On a scale of 1-5 (strongly disagree to strongly agree) please rate your level of agreement with the following statements regarding the most recent Cooperative Studies Program (CSP) #_____ Data Monitoring Committee Meeting

(Administrative/Timeliness)

1. The reports were received in time to perform an appropriate review.

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
1	2	3	4	5

2. Meeting plans (date, time, location, call in number) were effectively communicated prior to the meeting

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
1	2	3	4	5

(Competency)

3. Data in the report was presented in a clear and logical format for each focus area below, (not the study progress itself) :

   1. Study progress

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree	N/A
1	2	3	4	5

2. Safety data

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree	N/A
1	2	3	4	5

3. Primary and Secondary outcomes

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree	N/A
1	2	3	4	5

4. Data Quality

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree	N/A
1	2	3	4	5

(Communications)

4. The agenda clearly communicated the goals and expectations of the meeting.

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
1	2	3	4	5

5. The study team was prepared to discuss the study and respond to questions.

Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
1	2	3	4	5

6. Do you have any concerns about the information we provided in our reports?

YES NO

If yes, please provide suggestions for improvement.

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7. Do you have any concerns about the planning and conduct of our in-person meetings/conference calls?

YES NO

If yes, please provide suggestions for improvement.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Additional Comments:

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