Form 1 DATA CoIIN_Platform Training Survey_042018

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. The
OMB control number for this project is 0915-0212. Public reporting burden for this
collection of information is estimated to average 0.08 hours per response, including the
time for reviewing instructions, searching existing data sources, and completing and
reviewing the collection of information. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing
this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N-39,
Rockville, Maryland, 20857.

OMB Number (0915-0212) Expiration Date (05/31/2018)

IM CoIIN Platform Training Survey
Please select the rating for each section based on the following criteria:
5=excellent

4=good

3=average

2=fair 1=poor

Please rate the trainer(s) on the following:
1. Knowledge of the subject matter.

5

4

3

2

1

2. Ability to explain and illustrate concepts.

5

4

3

2

1

3. Ability to answer questions completely.

5

4

3

2

1

Open-ended comments:
4. What specifically did the trainer do well?

5. What recommendations do you have for the trainer to improve?
Please rate the content and structure of the training:
6. The usefulness of the information
received in training.

5

4

3

2

1

7. The structure of the training session(s).

5

4

3

2

1

8. The pace of the training session(s).

5

4

3

2

1

9. The convenience of the training schedule.

5

4

3

2

1

10. The usefulness of the training materials.

5

4

3

2

1

11. Was this training appropriate for your
level of experience?

Yes

No

If you said “No” to #11, please explain:
OMB Number (0915-0212) Expiration Date (05/31/2018)

Open-ended comments:
12. What did you like most about the training?

13. What can be improved with regard to the content, structure, format, and/or materials?

OMB Number (0915-0212) Expiration Date (05/31/2018)