Provider Training Evaluation Form by mvr5

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									                          DIVISION OF QUALITY MANAGEMENT
                    FALL 2009 PROVIDER TRAINING EVALUATION FORM


Date Attended:                                  Location/Site:

Your input is valuable to us in planning future Provider Training Sessions. Please take a moment to
complete this evaluation using the following scale:

1.   Strongly      2. Agree        3. Neutral        4. Somewhat        5. Strongly
     Agree                                              Disagree           Disagree

A.  SESSION CONTENT:
    1.        The session was well organized.
    2.        The session met my expectations
    3.        Questions were answered satisfactorily.
    4.        In general, the training was of benefit to me.
   5.        The session I benefitted most from was:
Quality Management      BPC Issues         Fire Safety     Waiver       Compliance       Audit

     Comments:

B.   TRAINERS/INSTRUCTORS:
     1.     Presented the material clearly.
     2.     Were knowledgeable and prepared.
     3.     Moved at an appropriate pace.
     4.     Were responsive to questions.

     Comments:

C.   FACILITY:

     1.          The room was orderly and clean.
     2.          The room was comfortable.
     3.          There was sufficient seating.

     Comments:

Do you have any suggestions (including topic requests) for future Provider Training Sessions?



Name (optional):
Title/Agency (optional):

Evaluation Forms may be emailed to Ellie.smith@omr.state.ny.us or Mailed to:
                           Ellie Smith
                           Division of Quality Management, 4th Floor
                           44 Holland Avenue
                           Albany, New York 12229

								
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