0917-0036 Gardening Survey

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

CN updated Gardening Survey protocol 5.29.19

IHS Chinle Service Unit Customer Experience Survey

OMB: 0917-0036

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Survey Protocol Worksheet

Date: May 2019

Survey Name: Customer Service- Community Nutrition Gardening Presentation

Survey Sponsoring Organization: Community Nutrition

Survey Coordinator: Alberta Gorman,

Purpose of Survey

To measure participants perception of customer service received by Community Nutrition staff.

Survey Questionnaire

Community Nutrition Customer Survey- Gardening Presentations and Demonstration


How will you choose to whom you will offer the survey?

All participants will be asked to complete the survey.

How often will the survey be done?

After each gardening presentation. .

How and by whom will the survey be administered?


Before the presentation the Survey will be placed on table with the sign in sheet. The presenter will ask participants to complete the survey. If needed the assistant (other staff) will give a survey to participant. The presenter will encourage the participants to complete survey and return it to the front table with the sign in sheet. The presenter will tally the number of completed surveys received and place them in envelope, with the sign in sheet.

Data Flow from Start to Finish

Work Table Participants Work Table Envelope OA (data entry)Quality Check data Analysis Report to Project Lead Report at CN monthly meeting

Destruction of Paper Questionnaires following Quality Check

How confidentiality will be assured?

The paper questionnaire will have no identifiers on it (i.e., no names or other identifiers). Questionnaires will be placed on table by the participants. And then to an envelope. Data is entered in Survey Monkey by OA. The paper questionnaire will be kept in a locked filing cabinet in Office Assistant’s work space until the quality check is completed. Then, the paper questionnaire will be destroyed by shredding.

How will the number of people offered and responding to the survey be recorded?

The presenter will complete a worksheet noting the percent of participants offered the survey and the percent of participants who have completed the survey (response rate) and given worksheet to the Office Assistant.

What steps are taken to assure quality data?

Presenter will encourage all participants to complete surveys. 40 surveys, numbered, will be available for each presentation. The Presenter will monitor the response rate and provide it and the surveys to the Office Assistant to enter in survey monkey. The Office Assistant will double check that data entered in survey monkey and excel file match the completed paper copy surveys. Compare distributing of responses for key question between hard copy and survey monkey at least twice a year.

Data Analysis

Data entered into the survey monkey will exported to excel file, store in the ‘O’ drive. The Office Assistance will send the excel file including graphs to the Vicki for Food Accessibility project on the Monday following the last of the presentations for the month. Project Lead will share results with the Community Nutrition staff at the monthly Community Nutrition meeting. Plot results by month with response rate and number of respondents. % strong agree

Who will receive the reports and how often?

Reports will be reviewed and discussed at the monthly Community Nutrition meeting, the first Thursday of every month.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorVeazie, Mark A (IHS/PHX)
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File Created2022-01-14

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