TRACIE Technical Assistance User Feedback Survey

Form Approved

OMB No. 0990-0391

Exp. Date XX/XX/20XX

TRACIE Technical Assistance User Feedback Survey

1. How did you request assistance from the TRACIE Assistance Center?

Email

Online

Toll-free telephone number

Don’t remember

2. What type of assistance did you request? (Select all that apply)

Policy guidance

Resource availability

Subject matter expertise

TRACIE web assistance

Other: ______________

3. Were you able to receive the assistance you needed?

Yes

No

Not Sure

4. [If responded: No] What assistance did you want, but weren’t able to receive?

_____________________________________________________________

5. How satisfied were you with the timeliness of the Assistance Center in responding to your initial inquiry (i.e., acknowledging your inquiries, not necessarily resolving it)?

1	Very Dissatisfied
2	Dissatisfied
3	Neither Dissatisfied nor Satisfied
4	Satisfied
5	Very Satisfied

6. How satisfied were you with the timeliness of the Assistance Center in resolving your inquiry?

   1	Very Dissatisfied
   2	Dissatisfied
   3	Neither Dissatisfied nor Satisfied
   4	Satisfied
   5	Very Satisfied

7. [If responded: Dissatisfied or Very Dissatisfied to either of the two questions above] Please explain how we can be timelier.

_____________________________________________________________

8. How satisfied were you with the quality of the assistance you received from expert(s) you consulted with?

1	Very Dissatisfied
2	Dissatisfied
3	Neither Dissatisfied nor Satisfied
4	Satisfied
5	Very Satisfied
6	I did not receive consultation from an expert

9. Overall, how satisfied were you with the quality of the assistance you received from the Assistance Center?

1	Very Dissatisfied
2	Dissatisfied
3	Neither Dissatisfied nor Satisfied
4	Satisfied
5	Very Satisfied

10. Overall, how satisfied were you with the TRACIE Assistance Center?

1	Very Dissatisfied
2	Dissatisfied
3	Neither Dissatisfied nor Satisfied
4	Satisfied
5	Very Satisfied

11. Please explain your response to the question above. _____________________________________________________________

12. What changes are needed to make the Technical Assistance Center more helpful? _____________________________________________________________

DEMOGRAPHICS

13. Please select the organization type that best represents the organization you represent.

Federal Government

Hospital

Non-Hospital Healthcare Facility

Individual

Non-Profit/Volunteer Organization

Coalition

State, Local, Tribal, or Territorial Government

Other:___________________

14. Are you a Hospital Preparedness Program grantee?

Yes

No

15. How many years of experience do you have in healthcare system preparedness?

Under 1 year

1-3 years

3-5 years

5-10 years

10+ years