Form 0917-0036 IHS CHR NET Plenary Evaluation Form

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

OMB No. 0917-0036, IHS CHR NET Plenary Evaluation Form

IHS CHR NET Plenary Evaluation Form

OMB: 0917-0036

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` Form Approved

OMB Form No. 0917-0036

Expiration Date:

2015 IHS CHR NET Plenary Evaluation Form

(Title of Plenary Session and Speaker Name(s) GO HERE and will be included prior to online survey release)



1. Please rate the following areas:


Poor

Fair

Good

Very Good

Excellent


The presenter was knowledgeable about the subject.


The information presented was clear and easy to understand.


The presenter was organized and prepared.


The session goals listed in the program booklet were met by the presenter.


My knowledge has increased after attending the session.


I can use this information in my community.


My personal behavior/lifestyle will change as a result of this session.



2. My knowledge, skills or abilities have been improved as a result of this session

(check all that apply):


Advocacy Supervision Monitoring Patients

Evaluation Role of IHS CHR Role Identification

Administration Collaboration Program Development

Leadership Communication Monitoring Patients

Access to Care Patient Care CHR Role Identification


3. Please describe the most important thing you learned at this session, how you intend to use it

in your work or life, and how you will share it with others who did not attend this session; or

feel free to make any other comments.











  1. IHS CHR NET Overall Evaluation Form


  1. I am attending the training as a(n):


Tribal Employee

Urban Employee

IHS Employee


Other Federal Employee

Contractor

Other (please specify):



2. How did you learn about the training? (Check all that apply):


CHR Program Website

Email

Colleague


Listserv

U.S. Postal Mail

Fax


Search Engine


3. How did you register for the meeting?


Online Registration

Fax Registration

Onsite


Registration


4. The process to register was:


Easy

Okay

Hard


5. The training website was:

Useful and easy to navigate

Not that helpful and hard to navigate

Not applicable



6. The final program booklet was:

Well organized and easy to use

Fragmented and hard to use

About right



7. The staff in the registration area was:

Pleasant and helpful

Unpleasant and not helpful

Okay



8. Overall, the meeting session topics presented were:

Relevant to my job

Not relevant to my job


9. The sessions were:

Too long

Just about right

Too short



10. The general session topics and speakers were:


Appropriate and informative

Inappropriate and unhelpful



11. The general sessions were:

Too long

Just about right

Too short



12. Overall, the meeting exhibitors/vendors were:


Appropriate and informative

Inappropriate and unhelpful



13. I had opportunities to network


Yes

No



14. The meeting theme and design were:

Culturally appropriate and conveyed the importance of CHRs

Culturally questionable and disregarded the importance of CHRs

Somewhere in-between



15. What did you like best about the meeting?






16. What did you like least about this meeting?






17. The meeting signs were:


Adequate and helpful

Need work for next time



18. Overall, the size and seating of session rooms were:


Appropriate and comfortable

Needed improvement



19. Overall, the meeting facilities were:


Satisfactory

Unsatisfactory



20. What specific ways could the meeting be improved?





21. List at least one item you would like to see produced, completed or addressed by the IHS HQ CHR program

by the next national meeting.





22. Optional: If you would like a direct response from the CHR Meeting Planning Committee, please

feel free to provide your name, employer, and contact information (phone, e-mail, address):





Thanks for helping us identify ways to improve training efforts!


According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0917-0036.  The time required to complete this information collection is estimated to average 8 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.


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File TitleSample Training Evaluation Form
Authorcamerona
Last Modified ByIHS
File Modified2015-05-06
File Created2015-05-06

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