Form Approved
OMB No. 0920-XXXX
Exp. Date: XX-XX-XXXX
CDC Work@Health™ Trainee Reaction Survey TRAIN-THE-TRAINER MODEL
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 may 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).
Respondents/Sources |
Method |
Content |
Timing |
Respondents |
Time per Respondent |
Trainees selected for the Work@Health™ Train-the-Trainer model |
Work@Health™ T4 Trainee Reaction Survey (collected online by PHMC) |
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At the conclusion of Train-the-Trainer training |
60 |
0.25 hrs |
This is a planned online survey of employers who participated in the Train-the-Trainer training model of the CDC Work@Health™ training program. Work@Health™ is a program that trains employers in the design, implementation, and evaluation of worksite health and wellness programs. This survey will be administered immediately after the training has been completed in Winter-Spring 2014 to evaluate the effectiveness of the train-the-trainer session.
Introduction
Thank you for your participation in today’s training 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 trainers.
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 sector consulting firm with a focus 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 and part of the ASHLIN Team designed this survey.
You are being asked to complete the survey because you participated in the Work@Health™ train-the-trainer 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 compelled by law. Your responses will be combined with other information we receive and reported in aggregate as feedback from all respondents. 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 extent you agree or disagree with each of the following statements.
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Strongly Disagree |
Disagree |
Neither disagree nor agree |
Agree |
Strongly agree |
Learning Environment |
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The next set of 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 |
Extremely Useful 5 |
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The next group of questions is about your perceptions of the individual training modules.
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Strongly Disagree |
Disagree |
Neither disagree nor agree |
Agree |
Strongly agree |
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19A. The learning objectives for the Understanding the Landscape module were clear. |
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19B. The learning objectives for the Building the Roadmap module were clear. |
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19C. The learning objectives for the Preparing for Delivery module were clear. |
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19D. The learning objectives for the Evaluating for Results module were clear. |
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19E. The learning objectives for the Supporting Technical Assistance module were clear. |
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19F. The learning objectives for the Completing a Practicum module were clear. |
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Strongly Disagree |
Disagree |
Neither disagree nor agree |
Agree |
Strongly agree |
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20A. The level of detail in the Understanding the Landscape module was appropriate. |
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20B. The level of detail in the Building the Roadmap module was appropriate. |
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20C. The level of detail in the Preparing for Delivery module was appropriate. |
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20D. The level of detail in the Evaluating for Results module was appropriate. |
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20E. The level of detail in the Supporting Technical Assistance module was appropriate. |
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20F. The level of detail in the Completing a Practicum module was appropriate. |
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Not at all informative |
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21A. How informative was the Understanding the Landscape module. |
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21B.How informative was the Building the Roadmap module. |
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21C. How informative was the Preparing for Delivery module. |
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21D. How informative was the Evaluating for Results module. |
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21E.How informative was the Supporting Technical Assistance module. |
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21F. How informative was the Completing a Practicum module. |
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22A. How useful was the Understanding the Landscape module. |
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22B.How useful was the Building the Roadmap module. |
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22C. How useful was the Preparing for Delivery module. |
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22D. How useful was the Evaluating for Results module. |
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22E.How useful was the Supporting Technical Assistance module. |
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22F. How useful was the Completing a Practicum module. |
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The next group of questions is about your overall impressions of the training. For each question, please indicate the degree to which you agree or disagree with the following statements.
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Strongly Disagree |
Disagree |
Neither disagree nor agree |
Agree |
Strongly agree |
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The next set of questions is about your ability to lead a worksite health and wellbeing training.
Finally we would like to know your thoughts and suggestions for how this program can be improved.
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Participant Characteristics
What is your title/role in your business?
Professional Instructor/Trainer
CEO/President/Owner
VP
Director, HR
Director, Benefits
Wellness Manager
Environmental Health and Safety Representative
Union/Labor Representative
Other (specify): ________________________
Number of employees at your site or business unit (full and part time):
_______________________________
Which of the following best describes your organization?
Health department
Professional Organization
Private employer
Broker
Non-profit
Business Coalition
Chamber of Commerce
Hospital/Health Care System
Other, please specify:__________________________________________
File Type | application/msword |
File Title | DRAFT PILOT TRAINING: HANDS-ON EVALUATION |
Author | schwarz-john |
Last Modified By | CDC User |
File Modified | 2013-11-20 |
File Created | 2013-11-20 |