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

Office of Safety Peer Exchange Evaluation

Final Draft Survey – Attendance at One Peer Exchange

Introduction

You are receiving this survey because you have attended the following peer exchange sponsored by the Federal Highway Administration (FHWA) Office of Safety between 2015 and 2018:

• Insert data tag [shortened title – month and year – State] (e.g., SHSP – Feb 2015 – MN)

The objective of this survey is to help us improve future peer exchanges by assessing your level of satisfaction with the peer exchange(s) you attended, and to investigate whether, and to what extent, you have been able to use what you learned at the peer exchange(s) to effect positive change in terms of safety-related projects, countermeasures, or other initiatives.

Participation in this questionnaire is voluntary. Information collected from this survey will be summarized and individual responses will not be identified.

Instructions

Please complete this survey by [DATE]. If you experience any technical issues using the survey tool, please contact Karen Weiss at karen.e.weiss@leidos.com. For questions about this effort, contact Tara McLoughlin at tara.mcloughlin@dot.gov.

Questionnaire Length – There are about [XX] items in this questionnaire, although the number of questions displayed to you will vary based on your responses to certain questions. Your progression through the questionnaire will be shown by a percentage complete at the top of the screen.

Saving Responses and Moving within the Questionnaire – Where it is allowable, you will be able to move back and forth within the questionnaire. Please use the “previous” and “next” buttons within the questionnaire itself. Do not use the browser “back” and “forward” buttons on your computer as using them may cause you to lose your data. Partial responses up to the last “next” button clicked will be saved.

Exiting and Returning to the Questionnaire – If you need to exit, please return using the link provided in the survey e-mail. This will allow you to return to where you stopped. Responses up to the last “next” button clicked will be saved.

OMB Burden Statement

This collection of information is voluntary and will be used to improve Federal Highway Administration Office of Safety peer exchanges. Public reporting burden is estimated to average [XX] minutes per response, including the time for reviewing instructions, gathering data if needed, and completing and reviewing the collection of information. The OMB control number for this collection is 2125-XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Highway Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.

Peer Exchange Attendance Questions

1. What role did you play at the peer exchange (check all that apply)?

1. Participant

2. Presenter

3. Facilitator

4. Host Agency

5. Other (describe)

Purpose and Expectation Questions

2. Indicate your peer exchange expectations and experiences.

	Before the peer exchange I attended, I expected to …			During the peer exchange I attended, I experienced…
	Yes	No	N/A	Yes	No	N/A
Increase my general level of knowledge on the subject
Learn something to use in my job at my agency
Share ideas and best practices among peers
Make valuable contacts with topic experts in peer organizations to share ideas in the future
Connect with FHWA topic area experts
Maintain or increase engagement in the topic area presented
Confirm and validate that my agency’s efforts are appropriate
Commit to an agency-specific action plan to implement after the peer exchange is over
Begin developing the agency-specific action plan at the peer exchange
Other

1. (If 3j=yes for expectation or experience) Describe your OTHER peer exchange expectations and experiences. (open ended)

Post Peer Exchange Activity Questions

The questions in this section address activities you and your agency undertook after the peer exchange you attended.

3. What actions did you take as a result of the peer exchange? (check all that apply)

1. Briefed leadership in my organization

2. Shared info with peers and colleagues

3. Developed an action plan to implement safety countermeasures or other life-saving initiatives

4. Implemented a strategy or idea presented at the peer exchange

5. Other (describe)

6. None

1. (If #4=none) If you did not take any actions as a result of the peer exchange, please explain why. (open ended)

2. (If #4=develop an action plan) Did you execute an action plan?

1. Yes

2. No

1. (If #4.2=did not execute action plan) Why?

1. Lack of support from leadership

2. Lack of support from others

3. Lack of resources to implement strategies

4. Lack of time to implement strategies

5. Not enough information on the topic to implement

6. Other (describe)

2. (If #4=implement strategy/idea or #4.2=yes, execute action plan) What challenges, if any, did you face in implementation? (open ended)

3. (If #4=implement strategy/idea or #4.2= yes, execute action plan) Did the peer exchange help you deal with challenges to implementing the new ideas?

1. Yes (describe)

2. No (describe)

4. (If #4=implement strategy/idea or #4.2= yes, execute action plan) What types of follow-up from FHWA were valuable in helping you implementing ideas learned at the peer exchange? (check all that apply)

1. Copies of presentations from the peer exchange

2. Peer exchange proceedings

3. List of contact information for all peer exchange participants

4. Announcements of resources and activities related to the peer exchange topic, e.g., webinars, new reports/guides/studies

5. Case studies and/or noteworthy practices developed as a result of the peer exchange

6. Contact by FHWA staff 6-12 months after the peer exchange

7. Regular status meetings with FHWA staff

8. Virtual check-ins with peer exchange participants

9. Technical assistance for implementing strategies

10. Technical assistance for evaluating strategies

11. Other (describe)

5. (If #4=implement strategy/idea or #4.2= yes, execute action plan) What strategies from the peer exchange are in the planning stages for future implementation? (open ended)

6. (If #4=implement strategy/idea or #4.2= yes, execute action plan) Are results (e.g., data, final reports) from any implemented strategies available?

1. Yes (describe)

2. No (describe)

7. (If #4=implement strategy/idea or #4.2= yes, execute action plan) Have you conducted any evaluations of implemented strategies?

1. Yes (describe)

2. No (describe)

8. (If #4=implement strategy/idea or #4.2= yes, execute action plan) Have any strategies been refined once implementation was initiated?

1. Yes

2. No

1. (If #4.2.6=yes, refined strategies) What was changed and were the changes effective? (open ended)

4. What tools, processes, or strategies do you need to implement ideas learned at a peer exchange? (check all that apply)

1. Template for developing an action plan

2. Working on the action plan at the peer exchange

3. Follow-up from FHWA

4. Additional interaction with peer exchange participants after the event

5. A way to track agency-specific action items

6. Successful examples from other agencies

7. Information on how to obtain support from leadership in my agency

8. Information on how to obtain support from key stakeholders in my agency

9. Other (describe)

1. (If #5=follow-up from FHWA and if #4≠implement strategy/idea or #4.2≠yes, execute action plan) What type of follow-up activities can FHWA provide to help you implement ideas learned at a peer exchange?

1. Copies of presentations from the peer exchange

2. Peer exchange proceedings

3. List of contact information for all peer exchange participants

4. Announcements of resources and activities related to the peer exchange topic, e.g., webinars, new reports/guides/studies

5. Case studies and/or noteworthy practices developed as a result of the peer exchange

6. Contact by FHWA staff 6-12 months after the peer exchange

7. Regular status meetings with FHWA staff

8. Virtual check-ins with peer exchange participants

9. Technical assistance for implementing strategies

10. Technical assistance for evaluating strategies

11. Other (describe)

5. What could be covered or included in future peer exchanges to aid the implementation of ideas learned? (check all that apply)

1. More unstructured networking time with peers

2. Short workshop sessions on particular topics

3. Report outs, concluding with action steps for each attendee/agency

4. More peer-to-peer discussion time built into the agenda

5. More presentations

6. Conducting the peer exchanges virtually instead of in person

7. Other (describe)

6. What further support do you need to help implement the knowledge gained at peer exchanges? (open ended)

Summary Questions

7. What was the most beneficial outcome of the peer exchange you attended? (open ended)

8. What resources, knowledge, skills, etc. did you receive from the peer exchange you attended that you did not expect? (open ended)

9. What changes would you make to peer exchange activities to make them more effective? (open ended)

10. Overall, the peer exchange met my expectations.

1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

1. Please describe. (open ended)

Follow-Up Questions

11. Are you willing to be contacted by phone for follow-up questions related to the survey?

1. Yes

2. No

12. Are you willing to participate in a 60-minute virtual follow-up focus group on peer exchanges?

1. Yes

2. No

13. (If #12 or #13=yes) Please enter your contact information to be contacted for follow-up.

1. First Name

2. Last Name

3. Business email address

May 16, 2019 1