TB Labs Site Visit Assessment

Appendix 1

Form Approved

OMB No. 0920-1027

Expiration Date: 08/31/2017

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1027).

Site Visit Evaluation: Immediate Follow-up

Recently, a Laboratory Capacity Team (LCT) Consultant from the Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Laboratory Branch, conducted a site visit at your TB laboratory. LCT would like to invite you to provide feedback on this recent site visit to enhance future site visits.

1. This was the first TB laboratory site visit I participated in.

☐ Agree

☐ Disagree

☐ Indifferent/No response

2. In preparation for the site visit, I reviewed the following information:

(Check all that apply)

☐ Past cooperative agreement data

☐ Performance reports/TARs

☐ Previous site visit reports

☐ Previous site visit recommendations

3. The length of the recent TB laboratory site visit was…

☐ Too long

☐ Too short

☐ Adequate

4. Reviewing our laboratory’s work allowed discussions to take place that informed or validated current processes, procedures, or algorithms.

☐ Agree

☐ Disagree

☐ Indifferent/No response

5. Questions that were asked of the laboratory consultant were either answered informatively or the laboratory consultant offered follow-up after returning to the office.

☐ Agree

☐ Disagree

☐ Indifferent/No response

6. Overall, the site visit was beneficial and was a good use of time.

☐ Agree

☐ Disagree

☐ Indifferent/No response

7. Suggestions or recommendations discussed during the site visit were useful and will be considered.

☐ Agree

☐ Disagree

☐ Indifferent/No response

☐ N/A Suggestions or recommendations were not discussed

8. The joint meeting with the laboratory, TB Control Program, and the Laboratory Consultant was valuable.

☐ Agree

☐ Disagree

☐ Indifferent/No response

☐ N/A We did not have an opportunity to spend time with the TB Control Program

9. Resources provided during the site visit were useful.

☐ Agree

☐ Disagree

☐ Indifferent/No response

☐ N/A I did not receive an informational packet

10. Additional information and resources that I would have liked to receive during the site visit included:

11. Agenda items or topics that were not discussed during the site visit that should be included are:

12. The site visit may be improved by:

    

    
    
    

    
    
    

13. Please provide any additional comments about the site visit.