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pdfOMB No. 1660NEW
Center for Domestic Preparedness
Level 1 Assessment Form
Expiration:
1. Indicate your primary discipline (choose only one).
2. My knowledge level of the
subject prior to completing
this course was
01 Emergency Management
02 Fire Service
07 Government Administrative
08 Healthcare (non-EMS)
03 HAZMAT
04 Law Enforcement
09 Public Health
10 Public Works
1 expert.
2 intermediate.
05 Public Safety Communications
06 Emergency Medical Services (EMS)
11 Other
3 basic.
3. Rate the quality of instruction from 0 (Very poor) to 5 (Excellent), as well as how much your knowledge and confidence increased from 0 (Not at
all) to 5 (Greatly).
Module
Quality of Instruction
My Knowledge
Increase
My Confidence
Increase
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
3. Rate the quality of facilitation from 0 (Very poor) to 5 (Excellent), as well as how much your skill and confidence increased from 0 (Not at all) to 5
(Greatly).
Module
Quality of
Facilitation
My Skill
Increase
My Confidence
Increase
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
4. The course (overall): Rate your experience from 0 (Not at all) to 5 (Totally).
a. employed a variety of instructional methods.
0 1 2 3 4 5
b. was an appropriate length for the material covered.
0 1 2 3 4 5
c. is worth recommending to others.
0 1 2 3 4 5
5. The instructors (overall):
a. answered questions thoroughly.
0 1 2 3 4 5
b. encouraged student participation.
0 1 2 3 4 5
c. covered all course learning objectives.
0 1 2 3 4 5
d. conducted themselves in a professional manner.
0 1 2 3 4 5
FEMA Form 092-0-2
6. Which part(s) of the training was/were the MOST valuable to you? Explain why.
7. Which part(s) of the training was/were the LEAST valuable to you? Explain why.
8. Provide any other comments you have on improving this course.
9. Classroom/training site(s) was/were: Rate from 0 (Very poor) to 5 (Excellent).
a. comfortable.
0 1 2 3 4 5
b. appropriate for the number of students.
0 1 2 3 4 5
10. Printed materials were:
a. well organized.
0 1 2 3 4 5
b. complete.
0 1 2 3 4 5
c. readable (i.e., printed well).
0 1 2 3 4 5
11. Audio-visual materials were:
a. of good quality.
0 1 2 3 4 5
b. appropriate to course content.
0 1 2 3 4 5
c. an enhancement to course content.
0 1 2 3 4 5
12. Student services
a. Questions regarding training and forms were answered
in a timely manner prior to attending this course.
0 1 2 3 4 5
b. Travel and information package was informative.
0 1 2 3 4 5
c. Transportation to and from classes was satisfactory.
0 1 2 3 4 5
d. Transportation to and from the airport was satisfactory.
0 1 2 3 4 5 NA
e. Inprocessing was efficiently handled.
0 1 2 3 4 5
f. Staff provided appropriate assistance.
0 1 2 3 4 5
g. Staff was responsive to my needs.
0 1 2 3 4 5
13. Facilities
a. Lodging was well maintained.
0 1 2 3 4 5 NA
b. A variety of food was available to meet my dietary needs.
0 1 2 3 4 5 NA
14. How did you hear about the CDP?
15. What is the best way to inform other responders about training available through the CDP?
16. I am better prepared to deal with disasters or
emergencies as a result of this training.
Yes
No
NA
1
2
NA
Public reporting burden for this,
survey is estimated to average 15
minutes per response. The burden
estimate includes the time for
reviewing instructions, searching
existing data sources, gathering and
maintaining the data needed, and
completing and submitting the
survey . You are not required to
respond to this collection of
information unless it displays a valid
OMB control number. Send
comments regarding the accuracy of
the burden estimate and any
suggestions for reducing the burden
to: Information Collections
Management, Department of
Homeland Security, Federal
Emergency Management Agency,
500 C Street, SW, Washington, DC
20472, Paperwork Reduction
Project (1660-XXXX). The following
collection of information is voluntary.
NOTE: Do not send your completed
form to this address.
| File Type | application/pdf |
| File Title | untitled |
| Author | donahuej |
| File Modified | 2011-09-08 |
| File Created | 2011-09-08 |