0920-23FZ Attachment 1A-Training Evaluation Instrument - Pre-test

Form Approved

OMB Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

Training Evaluation: Healthcare Outbreak Prevention and Response Curriculum for Public Health Departments

Data collection instrument: Pre-test

Data Elements

For all trainings: Knowledge domain How knowledgeable are you about initial steps for responding to healthcare outbreaks? How knowledgeable are you about responding to healthcare outbreaks across different healthcare facility types? How knowledgeable are you about recommendations for preventing the transmission of [insert pathogen] in [insert setting]? Attitudes domain How confident are you in being able to contribute to healthcare outbreak response? How confident are you in being able to independently provide effective initial consultation with healthcare facilities for potential outbreaks or infection control breaches? How confident are you in providing ongoing support, either onsite or remotely (where appropriate) until gaps have been fully addressed? Practices domain How many healthcare outbreak investigations have you participated in? How many IPC assessments have you participated in healthcare facilities?

Public reporting burden of this collection of information is estimated to average 5 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 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 Reports Clearance Officer, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA XXXX-XXXX