Online Model Evaluation Survey Form

Form Approved

OMB No. 0920-XXXX

Exp. Date: XX-XX-XXXX

CDC Work@Health PILOT TRAINING: ONLINE MODEL EVALUATION SURVEY

Public reporting of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency many not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

This is a planned online survey of employers who participated in the pilot test of CDC the Work@Health training program. Work@Health is an employer-based training on the design, implementation, and evaluation of workplace health and wellness programs. This survey will be administered immediately after the training has been completed in Fall - Winter 2013-2014 to evaluate the effectiveness of the online model training session.

Introduction

Thank you for your participation in the pilot training session for the CDC Work@Health program. This survey asks about your thoughts and opinions of the training. Your responses will help us make the Work@Health program most useful for employers.

Informed Consent

Before you get started, we’d like to give you some more information to help you decide whether or not you would like to participate.

• This project is funded by the Centers for Disease Control and Prevention (CDC). Many parts of this project are being managed by the ASHLIN Management Group (ASHLIN). ASHLIN is a private business consulting firm concentrating in the area of health and human services based in Greenbelt, MD. They are helping CDC implement the Work@Health program. The Public Health Management Corporation (PHMC), a non-profit, public health institute located in Philadelphia, PA is conducting this survey.

• You are being asked to complete the survey because you participated in the pilot test of the Work@Health training.

• Your participation is voluntary, and you may skip any questions you do not want to answer. You may also choose to end the survey at any time.

• The survey is designed to take about 15 minutes.

• There are no right or wrong answers or ideas – we want to hear about YOUR experiences and opinions.

• All of the comments you provide will be maintained in a secure manner. We will not disclose your responses or anything about you unless we are compelled by law. Your responses will be combined with other information we receive and reported in aggregate as feedback from the group. In our project reports, your name and your employer’s name will not be linked to the information or comments you provide.

• There are no risks or benefits to you personally for participating in this survey.

• CDC is authorized to collect information for this project under the Public Health Services Act.

• If you have any questions, you can contact Kristin Minot. Her phone number is 215-985-2519 and her email is Kristin@phmc.org.

Thinking about the Work@Health training you just completed, please indicate to what degree you agree or disagree with each of the following statements.

	Strongly Disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
Learning Environment
The online training was easy to understand.	1	2	3	4	5
The online training contributed to my knowledge of workplace health and wellness.	1	2	3	4	5
The pace of the activities was too slow.	1	2	3	4	5
The pace of the activities was too fast.	1	2	3	4	5
The length of the training course was too short.	1	2	3	4	5
The length of the training course was too long.	1	2	3	4	5
Delivery
I had enough time to complete the training activities.	1	2	3	4	5
I was given ample opportunity to get answers to my questions.	1	2	3	4	5
I did not have enough opportunity to practice the skills that I was asked to learn.	1	2	3	4	5
The online facilitator demonstrated a good understanding of the material.	1	2	3	4	5
The online facilitator effectively delivered the training activities, feedback assessments, and material.	1	2	3	4	5
The online facilitator did a poor job of generating participant interaction.	1	2	3	4	5
I was challenged by the training activities.	1	2	3	4	5
I was challenged by the training feedback assessments	1	2	3	4	5

The next questions are about the training activities. Please indicate how useful you found each of the following training activities:

How useful were:	Not at all Useful 1	Of little use 2	Moderately useful 3	Useful 4	Very Useful 5
The interactive infographics	1	2	3	4	5
The real world scenarios	1	2	3	4	5
The problem solving activities	1	2	3	4	5
The demonstrations	1	2	3	4	5
The online discussions	1	2	3	4	5
The integrated social media and professional tools	1	2	3	4	5

The next group of questions is about your perceptions of the individual training course modules.

	Strongly Disagree			Disagree		Neither disagree nor agree			Agree	Strongly agree
18A. The learning objectives for the Making the Business Case module were clear.	1			2		3			4	5
18B. The learning objectives for the Assessing Your Company’s Current Support of Employee Health and Wellness module were clear.	1			2		3			4	5
18C. The learning objectives for the Planning and Designing a Comprehensive and Effective Program module were clear.	1			2		3			4	5
18D. The learning objectives for the Building and Sustaining a Total Leadership Approach module were clear.	1			2		3			4	5
18E. The learning objectives for the Implementing Key Policy, Benefit, and Environmental Supports module were clear.	1			2		3			4	5
18F. The learning objectives for the Designing an Effective Communications Campaign module were clear.	1			2		3			4	5
18G. The learning objectives for the Implementing and Sustaining Your Program module were clear.	1			2		3			4	5
18H. The learning objectives for the Evaluating Your Program module were clear.	1			2		3			4	5
19A. The level of detail in the Making the Business Case module was appropriate.	Strongly Disagree		Disagree			Neither disagree nor agree		Agree		Strongly agree
19B. The level of detail in the Assessing Your Company’s Current Support of Employee Health and Wellness module was appropriate.	1		2			3		4		5
19C. The level of detail in the Planning and Designing a Comprehensive and Effective Program module was appropriate.	1		2			3		4		5
19D. The level of detail in the Building and Sustaining a Total Leadership Approach module was appropriate.	1		2			3		4		5
19E. The level of detail in the Implementing Key Policy, Benefit, and Environmental Supports module was appropriate.	1		2			3		4		5
19F. The level of detail in the Designing an Effective Communications Campaign module was appropriate.	1		2			3		4		5
19G. The level of detail in the Implementing and Sustaining Your Program module was appropriate.	1		2			3		4		5
19H. The level of detail in the Evaluating Your Program module was appropriate.	1		2			3		4		5
		Not at all informative			Not very informative		Somewhat informative			Very Informative
20A. How informative was the Making the Business Case module.		1			2		3			4
20B.How informative was the Assessing Your Company’s Current Support of Employee Health and Wellness module.		1			2		3			4
20C. How informative was the Planning and Designing a Comprehensive and Effective Program module.		1			2		3			4
20D. How informative was the Building and Sustaining a Total Leadership Approach module.		1			2		3			4
20E.How informative was the Implementing Key Policy, Benefit, and Environmental Supports module.		1			2		3			4
20F. How informative was the Designing an Effective Communications Campaign module.		1			2		3			4
20G. How informative was the Implementing and Sustaining Your Program module.		1			2		3			4
20H. How informative was the Evaluating Your Program module.		1			2		3			4
		Not at all useful			Not very useful		Somewhat useful			Very useful
21A. How useful was the Making the Business Case module.		1			2		3			4
21B.How useful was the Assessing Your Company’s Current Support of Employee Health and Wellness module.		1			2		3			4
21C. How useful was the Planning and Designing a Comprehensive and Effective Program module.		1			2		3			4
21D. How useful was the Building and Sustaining a Total Leadership Approach module.		1			2		3			4
21E.How useful was the Implementing Key Policy, Benefit, and Environmental Supports module.		1			2		3			4
21F. How useful was the Designing an Effective Communications Campaign module.		1			2		3			4
21G. How useful was the Implementing and Sustaining Your Program module.		1			2		3			4
21H. How useful was the Evaluating Your Program module.		1			2		3			4

The next group of questions are about your overall impressions of the training. For each question, please indicate the degree to which you agree or disagree with the following statements.

	Strongly Disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
22. The learning objectives were clear.	1	2	3	4	5
23. I understand how to apply what I learned in this training at my job.
24. I will be able to use what I learned in this training at my job.	1	2	3	4	5
25. I would recommend this online training to others in my position.	1	2	3	4	5
26. The training topics met my needs.	1	2	3	4	5
27. The online training met my expectations.	1	2	3	4	5
28. The Work@Health training was effective.	1	2	3	4	5

The next sets of questions are about your ability to start or expand a workplace health program at your place of employment.

29. How confident are you in your ability to start or expand a workplace health program at your organization? (Circle one rating)

1. Not at all confident

2. A little confident

3. Confident

4. Very Confident

5. Extremely Confident

If you circled 2 or lower, please answer the following questions. Check all that apply.

30. My confidence is not high because:

1. I do not have the necessary knowledge and skills.

2. I do not have a clear picture of what is expected of me.

3. I have other priorities.

4. I do not have the necessary resources to do it.

5. I do not have the support from my employer to do it.

6. Other (please explain).

Finally we would like to know your thoughts and suggestions for how this program can be improved.

31. Did you experience any technical difficulties with the online training?	Yes No If Yes, please explain.
32. What changes, if any, would you recommend to the Work@Health program? For example, would you recommend changes to the objectives, activities, assessments, materials or format of the training?
33. Topics to be covered in the Work@Health training will include making the case for a healthy worksite, leadership and motivation, data collection methods and tools, health promotion and safety, and program evaluation. What additional topics do you think should be covered in a workplace health and wellness training?
34. How did you learn about the Work@Health program?	Through a business association (e.g., Small Business Association) Website Letter in the mail Newspaper Radio
35. What would encourage or motivate other employers/others in your position to attend a Work@Health training?
36. What is the best way to reach other businesses like yours and tell them about the Work@Health program?
37. What was the most important thing that you learned from the Work@Health training?
38. What did you like the least about the Work@Health training?
39. What did you like the most about the Work@Health training?

Employee Characteristics

40. What is your business title/role?

• CEO/President/Owner

• VP

• Director, HR

• Director, Benefits

• Wellness Manager

• Environmental Health and Safety Representative

• Union/Labor Representative

• Other (specify): ________________________

41. Number of employees at your site or business unit

• 30

• 31 to 50

• 51 to 100

• 101 to 500

• More than 500

42. What industry best describes your worksite?

• Agriculture, Forestry, Fishing and Hunting

• Mining, Quarrying, and Oil and Gas Extraction

• Utilities

• Construction

• Manufacturing

• Wholesale Trade

• Retail Trade

• Transportation and Warehousing

• Information

• Finance and Insurance

• Real Estate and Rental and Leasing

• Professional, Scientific, and Technical Services

• Management of Companies and Enterprises

• Administrative and Support and Waste Management and Remediation Services

• Educational Services

• Health Care and Social Assistance

• Arts, Entertainment, and Recreation

• Accommodation and Food Services

• Public Administration

• Other Services (specify) _________________________

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