Form 1 NCI OSFM Fitness Survey

NCI OSFM Fitness Survey

OMB No.: 0925-0648
Expiration Date: 03/31/2018
Public reporting burden for this collection of information is estimated to average 2 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: NIH, Project Clearance Branch, 6705 Rockledge Drive,
MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

1. Please answer all that apply to you and skip any item that doesn't apply. Thanks.
Unsatisfactory

Poor

Satisfactory

Good

Outstanding

N/A

Locker room and shower
areas are clean and
orderly with no offensive
odors
Exercise equipment is
clean and free of dust
and perspiration
Equipment is kept in
proper working order
Program fliers and
brochures are distributed
early enough to allow for
enrollment in chosen
program
Program fliers and
brochures provide clear
information about
program time, place and
content

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2. Please answer all that apply to you and skip any item that doesn't apply. Thanks.
Unsatisfactory

Poor

Satisfactory

Good

Outstanding

N/A

Does the Fitness Center
currently offer classes
that you are interested
in?
Staff respond to my
questions and requests
promptly
Staff are on time for our
appointments
Does the Fitness Center
currently provide
equipment that you
prefer?
Staff are friendly,
courteous, available and
willing to help
New routines in group
exercise classes are
introduced gradually and
are easy to follow

3. Comments/Suggestions

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