New kellen logo rgb3
KELL - SCHEDULE GRID TESTER
Mr pencil

How would you like your name to appear on your certificate?



How many credit hours did you complete?
Agreement
By completing this form, you attest that you have attended the number of hours you have indicated above.
Notice to Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numeric license number (e.g. CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours. 
Notice to OhioLicensees: In order for us to report your hours to CE Broker, you MUST provide us with your Ohio alpha-numeric license number (e.g. CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours. 
CHES MEMBERS ONLY -- Please enter your CHES ID#
Was the educational content of value to you?
Please rate your satisfaction with the content and quality of the program: 
Was the educational content scientifically sound?
Was the educational content scientifically sound?
If no, please explain...
If no, Tell us how...
Did you perceive any commercial bias or influence in the educational content?
If yes, what...
Did you perceive any commercial bias or influence in the educational content?
Did this program improve your competence or performance? 
If yes, how...
If no, please explain...
If yes, what...
What did you learn that will help you in your practice?
The program was up-to-date and relevant to my professional practice.
Did this program improve your Skill or Strategy in your role or contribution as a member of the healthcare team?
If no, why not?
Do you believe your participation in this activity will positively impact your healthcare team?
Was the location suitable?
The facilities were conducive to learning.
If yes, tell us how... Or if no, tell us why not...
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Were the following objectives met?
ENTER OBJECTIVE OR REMOVE
Do you think what you learned will benefit you in your practice?
Rate the following for all instructors
Instructor was knowledgeable about the content.
Rate the following for all instructors
Instructor presented the subject matter clearly.
Rate the following for all instructors
Instructor was responsive.
Rate the following for all instructors
Instructor used technology, hand outs and other learning aids effectively.
Additional questions about the instructor(s)
If yes, how...
What questions are you having in your practice that you would like to see addressed in an educational activity?
Were questions, concerns and accommodations were addressed efficiently and in a timely manner?
Additional comments, questions or concerns.
Tell us how well or poorly we met any of the educational objectives:
How did you attend this course? 
What questions are you having in your practice that you would like to see addressed in an educational activity?
What barriers might you have that would interfere with implementation of new information learned from this training?
How can this training (the overall meeting) be improved to better impact knowledge, strategies/skills, performance and/or patient outcomes?
Tell us what was good or bad about any part of the educational activity, content, speakers, materials, anything at all.
Mr question
Provided by amedco