Evidence-Based Inquiry Form
Submit your responses to support an evidence-based assessment. Please answer all questions thoughtfully.
Your Name
*
First Name
Last Name
Your Role or Position
*
Date of Submission
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which area best describes the focus of your inquiry?
*
Please Select
Clinical Practice
Education
Policy
Research
Other
How relevant is the evidence to your inquiry?
*
Not relevant
1
2
3
4
Highly relevant
5
1 is Not relevant, 5 is Highly relevant
How would you rate the quality of the evidence?
*
1
2
3
4
5
Please evaluate the following aspects of the evidence:
*
Rows
Poor
Fair
Good
Excellent
Clarity
1
2
3
4
Objectivity
5
6
7
8
Recency
9
10
11
12
Applicability
13
14
15
16
How confident are you in applying this evidence?
*
Very confident
Somewhat confident
Neutral
Somewhat unconfident
Not confident at all
Describe any barriers to implementing the evidence.
Additional comments or recommendations
Submit
Should be Empty: