Participant Information
All fields in this section are required.
1. Location
New York State Location
State other than New York State
2. What is your highest
academic degree?
High School
Associates Degree
Bachelors Degree
Masters
Doctorate
3. Which of the following best describes your current
work role?
Front Line Staff
Senior Staff Level
Supervisory and Management Staff
Front Line Staff (carry out day-to-day tasks
including clinical, fieldwork, and outreach)
Senior Staff Level (technical
and specialized functions, may supervise individual units)
Supervisory
and Management Staff (responsible for major programs, planning,
provide policy recommendations)
4. Primary Occupation
Administrative/ Managerial
Educator/ Trainer
Clinical: Nursing
Clinical: Physician, Nurse Practitioner, Physician's
Assistant
Dentist
Pharmacist
Veterinarian
Epidemiology/ Biostatistics
Environmental Health
Emergency Services
Legal Counsel or Staff
Communications/ Media Relations
Clerical/ Support Staff
Student
Other
5. Primary Work Setting
Local Health Dept.
State Health Dept.
Other State Agency
Hospital
Long-term Care Facility
Other Health Care Facility
Private Medical Practice
College/University
Business/Industry
Other
6. Years in Current Occupation
Evaluation (ranked responses)
7. The program moderator for "Terrorism
Preparedness: Effecting Local Response from a National Plan" was helpful
in framing
questions and focusing discussion.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
8. The speaker presenting
"Terrorism Preparedness: Effecting Local Response from a National Plan"
was knowledgeable.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
9. The speaker presenting
"Terrorism Preparedness: Effecting Local Response from a National Plan"
was effective
in communicating concepts.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
10. The specific objectives successfully
met the overall goal of the program.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
11. I found the length of
this program appropriate to cover content.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
12. The topic is relevant to
my current employment.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
13. The program satisfied
my educational needs.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
14. The program will enhance
performance of my duties.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
15. I would recommend this program
to others.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
16. I understand the objectives
for this training.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
17. Overall, the training
was a valuable learning experience.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
18. As a result of this broadcast,
I am better able to discuss the scope of U.S. plans for developing
community preparedness.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
19. As a result of this broadcast,
I can identify mistakes made in the recent past related to planning
and response.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
20. As a result of this broadcast,
I am able to suggest ways to better utilize national and regional resources.
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
COMMENTS
Type your responses in the boxes provided.
All fields in this section are optional.
21. What was the most useful or
important thing you learned during this program?
22. What suggestions do you have
for improving the program?
23. Other comments about this
program.
24. Other topics of interest you would like to
learn more about in future Center for Public Health Preparedness educational
activities.
CONTINUING EDUCATION CREDITS
If you are interested in receiving
continuing education credits, please click one of the boxes below and
then enter your name and mailing address in the space provided.
The School of Public Health, University at Albany, SUNY, is accredited
by the Medical Society of the State of New York to sponsor continuing
medical education for physicians. The School designates this program
for 1 hour in Category One credit towards the AMA/PRA Physician’s
Recognition Award. Each physician should claim only those hours of
credit he/she actually spent in the educational activity.
Please enroll me for 1 hour in Category One Continuing Medical
Education credit towards the AMA/PRA Physician’s Recognition
Award.
This Educational Design I activity
is presented by the School of Public Health Continuing Education, which
has been approved as a provider of continuing education by the New
York State Nurses Association’s Council on Continuing Education,
which is accredited by the American Nurses' Credentialing Center's
Commission on Accreditation. It has been assigned approval code 54NLRE-PRV-02-049.
Please enroll me for 1 contact hour in nursing continuing
education.
Name:
Mailing Address: