SOCIAL WORK & FAMILY PHYSICIANS POST-TRAINING SURVEY
Form Approved
OMB No. 0920-XXXX
Exp. Date xx/xx/20xx
Instructions: Please answer the questions below. Your responses will be kept secure, and will be summarized only in aggregate with those of other respondents. Individual, identifiable responses will NOT be shared.
Overall, how satisfied are you with the content and quality of this training?
Very Satisfied__ Satisfied__ Neutral__ Dissatisfied__ Very Dissatisfied__
How satisfied are you with the ease and functionality of the training module?
Very Satisfied__ Satisfied__ Neutral__ Dissatisfied__ Very Dissatisfied__
The training program presented FASD concepts clearly.
Strongly Disagree__ Disagree__ Neutral__ Agree__ Strongly Agree__
The content of the program related to the learning objectives.
Strongly Disagree__ Disagree__ Neutral__ Agree__ Strongly Agree__
The training enables me to serve my patients/clients better.
Strongly Disagree__ Disagree__ Neutral__ Agree__ Strongly Agree__
What suggestions do you have for improving this training? ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
After participating in the FASD training program, how much do you know about FASD?
Very little Some A lot
1 2 3 4 5
How likely are you to use the skills learned in this FASD training program in your practice?
Not Likely Somewhat Likely Very Likely
1 2 3 4 5
The training increased my knowledge of SBI.
Strongly Disagree__ Disagree__ Neutral__ Agree__ Strongly Agree__
The training enhanced my skills in screening and intervention to help avoid Alcohol Exposed Pregnancies (AEP).
Strongly Disagree__ Disagree__ Neutral__ Agree__ Strongly Agree__
CDC
estimates the average public reporting burden for this collection of
information as 5
minutes
per response, including the time for reviewing instructions,
searching existing data/information sources, gathering and
maintaining the data/information 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 currently 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 Information Collection Review
Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:
PRA (0920-XXXX).
| File Type | application/msword |
| Author | rustveld |
| Last Modified By | Green, Patricia P. (CDC/ONDIEH/NCBDDD) |
| File Modified | 2016-02-19 |
| File Created | 2016-02-19 |