Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation

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

OMB: 0935-0179

IC ID: 244358

Documents and Forms

Document Name Document Type
Form 1 Building Diagnostic Safety Capacity – TeamSTEPPS® Course Evaluation Form and Instruction
1 Appendix A: Setting Demographics Survey Appendix A_final cg 11 12 20.docx Form and Instruction
2 Appendix B: Individual Respondent Characteristics (Providers) Appendix B_final_v2 cg 11 12 20.docx Form
3 Appendix C: Individual Respondent Characteristics (Staff) Appendix C_final_v2 cg 11 12 20.docx Form and Instruction
4 Appendix D: Individual Respondent Characteristics (Admin) Appendix D_final_v2 cg 11 12 20.docx Form and Instruction
5 Appendix E: Organizational Readiness for Implementation Change (ORIC) Appendix E.docx Form and Instruction
6 Appendix F: Pilot Test Interview Protocol for Providers – TeamSTEPPS® Appendix F.docx Form and Instruction
7 Appendix G: Pilot Test Interview Protocol for Providers – No TeamSTEPPS® Appendix F.docx Form and Instruction
8 Appendix H: Pilot Test Evaluation Protocol for Staff – TeamSTEPPS® Appendix H.docx Form and Instruction
9 Appendix I: Pilot Test Evaluation Protocol for Staff – No TeamSTEPPS® Appendix I.docx Form and Instruction
10 Appendix J: Pilot Test Evaluation Protocol for Administrators – TeamSTEPPS® Appendix J.docx Form and Instruction
11 Appendix K: Pilot Test Evaluation Protocol for Administrators – No TeamSTEPPS® Appendix K.docx Form and Instruction
12 Appendix L: Training Observation Tool Appendix L.docx Form and Instruction
OMB Cover Letter.docx Cover Letter IC Document
Supporting Statement Part A.docx Supporting Statement IC Document