Evaluation Protocol Form
Please complete this form to assess the specified use case or protocol. Your feedback will help us ensure quality and suitability.
Protocol or Use Case Title
*
Evaluator Name (First and Last)
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Brief Description of the Protocol/Use Case
*
Clarity of Protocol Instructions
*
Very unclear
1
2
3
4
Extremely clear
5
1 is Very unclear, 5 is Extremely clear
Feasibility of Implementation
*
Not feasible
1
2
3
4
Highly feasible
5
1 is Not feasible, 5 is Highly feasible
Overall Risk Assessment
*
Low risk
Moderate risk
High risk
Uncertain
Impact Potential
*
Minimal impact
1
2
3
4
Major impact
5
1 is Minimal impact, 5 is Major impact
Detailed Evaluation Matrix
*
Rows
Poor
Fair
Good
Excellent
Documentation Quality
1
2
3
4
Stakeholder Alignment
5
6
7
8
Resource Availability
9
10
11
12
Measurability of Outcomes
13
14
15
16
Additional Comments or Recommendations
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