Form 1 Feedback Form

Region _____________

O MB #0970-0401
Expiration Date: 05/31/2018

Training Topic:

Date:

Please rate the trainer(s). Circle the appropriate numbers. Provide any additional feedback in the comments section.

RATING SCALE: 1 = Low 2 = Fair 3 = Good 4 = High

Trainer Name(s)	Topic Expertise				Clarity				Time Management				Responsiveness
	1	2	3	4	1	2	3	4	1	2	3	4	1	2	3	4
	1	2	3	4	1	2	3	4	1	2	3	4	1	2	3	4

Please review the following list of training objectives. Circle the number that best represents your knowledge and skills before then after this training.

RATING SCALE: 1 = Low 4 = High

Before Training				Self-assessment of knowledge and skills related to:	After Training
1	2	3	4	[INSERT TRAINING OBJECTIVES]	1	2	3	4
1	2	3	4	[INSERT TRAINING OBJECTIVES]	1	2	3	4
1	2	3	4	[INSERT TRAINING OBJECTIVES]	1	2	3	4

RATING SCALE: 1 = Strongly Disagree 2 = Disagree 3 = Agree 4 = Strongly Agree

Please mark a check (√) to rate your impressions of the items listed below.	1	2	3	4	Not applicable
The information and materials are relevant to my work.
A variety of modalities (visual, hands-on, auditory) were used to support learning.
There were opportunities for practice, discussion and feedback.
The session enhanced my knowledge and/or skills.

Two strategies or resources I will put into practice or share with others are:	I am specifically interested in the following topics/areas:
Additional Comments:

Optional:

Name:

Contact Information:

Role:

These materials were developed for OHS/Regional TTA Network.

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