Your Heart, Your Life: A Community Health Worker's Manual for the Hispanic Community

Session 12 Handout Feedback Form – What Did You Think About the Training? (for Strategy 1)

Download Feedback Form – What Did You Think About the Training? (for Strategy 1) pdf document (48k, 2 pages) handout.

Participant identification (ID) number (optional):

Date (MM/DD/YYYY):

City:

State:

Circle only one answer for each question 1-10 and 14-18. Write your answers to questions 11-13 and 19-21.

  1. The training you attended was: Poor, Fair, Good, Very Good, Excellent, N/A
  2. The handouts in the manual were: Poor, Fair, Good, Very Good, Excellent, N/A
  3. The picture cards were: Poor, Fair, Good, Very Good, Excellent, N/A
  4. The demonstrations were: Poor, Fair, Good, Very Good, Excellent, N/A
  5. The audiovisuals were: Poor, Fair, Good, Very Good, Excellent, N/A
  6. The content presented was: Poor, Fair, Good, Very Good, Excellent, N/A
  7. The educational materials were: Poor, Fair, Good, Very Good, Excellent, N/A
  8. The trainer's knowledge of the manual content was: Poor, Fair, Good, Very Good, Excellent, N/A
  9.  The way the trainer taught the manual was: Poor, Fair, Good, Very Good, Excellent, N/A
  10. The activities you participated in (e.g., role plays, pledges, etc.) were: Poor, Fair, Good, Very Good, Excellent, N/A

Write your answers to the following questions.

  1. What did you like best about the training?
  2. What did you like least about the training?
  3. Are there any areas that should be improved for future trainings?

Circle only one answer for each question.

  1. Will you teach the Your Heart, Your Life course to community members?: I will not, Most likely I will not, Don't know, Most likely I will, I will
  2. Will you change your health habits?: I will not, Most likely I will not, Don't know, Most likely I will, I will
  3. Will you share the information from the training with your family?: I will not, Most likely I will not, Don't know, Most likely I will, I will
  4. Will you share the information from the training with friends?: I will not, Most likely I will not, Don't know, Most likely I will, I will
  5. Will you share the information from the training with promotores?: I will not, Most likely I will not, Don't know, Most likely I will, I will
  6. Are there other ways that you can share the information? Yes, No
    If yes, please explain:
  7. What changes will you make as a result of participating in the training?
  8. Other comments:

Back to Session 12

Information on this page is taken from the English print version of “Your Heart, Your Life, A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.




Last Updated March 2012




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