Form 0920-1050 Post Site Visit Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Post site visit survey questions_Clearance

Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement

OMB: 0920-1050

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Post site visit survey questions



  1. Please select the start date for your recent site visit.



  1. How would you rate the communication between your facility and the NAC team prior to the site visit?

  2. Very satisfied, satisfied, neutral, dissatisfied, very dissatisfied

  3. [Comments text box for free response]



  1. Did the NAC team communicate with you prior to the visit to clearly understand the laboratory containment entry requirements at your facility?

  2. Yes, no, not applicable (this was a remote site visit)

  3. [Comments text box for free response]

  4. How satisfied were you with the document upload process?

  5. Very satisfied, satisfied, neutral, dissatisfied, very dissatisfied

  6. [Comments text box for free response]

  7. How satisfied are you with the way in which the NAC team applied WHO GAPIII during the site visit?

  8. Very satisfied, satisfied, neutral, dissatisfied, very dissatisfied

  9. [Comments text box for free response]



  1. How satisfied were you with the professionalism of the NAC team?

  2. Very satisfied, satisfied, neutral, dissatisfied, very dissatisfied

  3. [Comments text box for free response]



  1. How satisfied were you with the NAC team's technical expertise?

  2. Very satisfied, satisfied, neutral, dissatisfied, very dissatisfied

  3. [Comments text box for free response]



  1. How helpful did you find the NAC team's briefings at the start of your visit?

  2. Very helpful, somewhat helpful, neither helpful or unhelpful, not very helpful, not at all helpful

  3. [Comments text box for free response]



  1. How helpful did you find the NAC team’s briefings at the end of each day?

  2. Very helpful, somewhat helpful, neither helpful or unhelpful, not very helpful, not at all helpful, not applicable (visit only one day)

  3. [Comments text box for free response]



  1. How satisfied were you with the NAC team's out briefing at the conclusion of your site visit?

  2. Very satisfied, satisfied, neutral, dissatisfied, very dissatisfied

  3. [Comments text box for free response]



  1. Did you receive satisfactory responses to your questions during the site visit?

  2. Yes, no

  3. [Comments text box for free response]



  1. How well prepared was the NAC team to inspect your facility?

  2. Very well prepared, somewhat prepared, not well prepared

  3. [Comments text box for free response]



  1. Did the NAC team conduct the visit in a manner so that your operations were minimally impacted?

  2. Yes, no

  3. [Comments text box for free response]

  4. If this was a remote site visit, did you encounter any technology issues or limitations during the remote visit?

  5. Yes, no, not applicable (this was not a remote visit)

  6. [Comments text box for free response]

  7. How would you rate this NAC visit as compared to previous visits?

  8. Improved, about the same, needs improvement, not applicable (this was the facility’s first site visit)

  9. [Comments text box for free response]



  1. Please provide any recommendations that you may have for improving future NAC site visits

  2. [Comments text box for free response]









File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMyrick, Christy A. (CDC/DDPHSIS/CPR/OD)
File Modified0000-00-00
File Created2021-01-12

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