Surveillance Program Voluntary Assessment Form
Please complete the Surveillance Program Voluntary Assessment Form to share your feedback and experience. Your responses help us evaluate and improve the program.
How would you rate your overall experience with the surveillance program?
*
1
2
3
4
5
How effective do you feel the surveillance program is in achieving its stated goals?
*
Not effective
1
2
3
4
Highly effective
5
1 is Not effective, 5 is Highly effective
How easy was it to participate in the surveillance program?
*
Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
Which aspect of the program did you find most valuable?
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Communication and updates
Ease of use
Support from staff
Training and resources
Other
Please indicate your level of agreement with the following statements:
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
The program was clearly explained to me
1
2
3
4
5
I felt comfortable participating
6
7
8
9
10
I received adequate support when needed
11
12
13
14
15
How likely are you to recommend participation in the surveillance program to others?
*
Not likely
1
2
3
4
Extremely likely
5
1 is Not likely, 5 is Extremely likely
What improvements would you suggest for the surveillance program?
Did you encounter any challenges or barriers while participating?
*
No
Yes
If yes, please describe the challenges or barriers you encountered.
Please share any additional comments or feedback about your experience with the surveillance program.
Submit Assessment
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