Prevention Agenda Sessions Baseline Survey
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1. NYSACHO Prevention Agenda Presentations Baseline Survey

Through a grant from the NYS Department of Health, NYSACHO has been offering sessions, at our regular membership meetings, featuring LHD best practices and initiatives related to New York State's Prevention Agenda Priorities. In order to assess the impact of these presentations, we ask that you complete the survey below.

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1. Contact Information:

Contact Information: NAME:
LHD:
Email:

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2. Please indicate if you attended the following Prevention Agenda General Membership Sessions. Choose either in person or by phone/webinar.

Please indicate if you attended the following Prevention Agenda General Membership Sessions. Choose either in person or by phone/webinar. IN PERSON Preparedness Update (Mar. 2011)

WEBINAR Preparedness Update (Mar. 2011)

IN PERSON Falls Prevention (Feb. 2011)

WEBINAR Falls Prevention (Feb. 2011)

IN PERSON Falls Prevention (Jan. 2011)

WEBINAR Falls Prevention (Jan. 2011)

IN PERSON Tobacco Control: Evidence-based Interventions (Dec. 2010)

WEBINAR Tobacco Control: Evidence-based Interventions (Dec. 2010)

IN PERSON Chronic Disease Prevention: Strategic Alliance for Health (Sept. 2010)

WEBINAR Chronic Disease Prevention: Strategic Alliance for Health (Sept. 2010)

I did not attend any Prevention Agenda General Membership Sessions.

3. The material was relevant to what I am doing in my community:

	Strongly Agree	Agree	Not Sure	Disagree	Strong Disagree	Did Not Attend
Falls Prevention (both)	*The material was relevant to what I am doing in my community: Falls Prevention (both) Strongly Agree	Falls Prevention (both) Agree	Falls Prevention (both) Not Sure	Falls Prevention (both) Disagree	Falls Prevention (both) Strong Disagree	Falls Prevention (both) Did Not Attend
Tobacco Control	Tobacco Control Strongly Agree	Tobacco Control Agree	Tobacco Control Not Sure	Tobacco Control Disagree	Tobacco Control Strong Disagree	Tobacco Control Did Not Attend
Chronic Disease Prevention	Chronic Disease Prevention Strongly Agree	Chronic Disease Prevention Agree	Chronic Disease Prevention Not Sure	Chronic Disease Prevention Disagree	Chronic Disease Prevention Strong Disagree	Chronic Disease Prevention Did Not Attend
Preparedness Update	Preparedness Update Strongly Agree	Preparedness Update Agree	Preparedness Update Not Sure	Preparedness Update Disagree	Preparedness Update Strong Disagree	Preparedness Update Did Not Attend

4. The knowledge gained from this program will help me move forward more effectively:

	Strongly Agree	Agree	Not Sure	Disagree	Strongly disagree	Did Not Attend
Falls Prevention (both)	*The knowledge gained from this program will help me move forward more effectively: Falls Prevention (both) Strongly Agree	Falls Prevention (both) Agree	Falls Prevention (both) Not Sure	Falls Prevention (both) Disagree	Falls Prevention (both) Strongly disagree	Falls Prevention (both) Did Not Attend
Tobacco Control	Tobacco Control Strongly Agree	Tobacco Control Agree	Tobacco Control Not Sure	Tobacco Control Disagree	Tobacco Control Strongly disagree	Tobacco Control Did Not Attend
Chronic Disease	Chronic Disease Strongly Agree	Chronic Disease Agree	Chronic Disease Not Sure	Chronic Disease Disagree	Chronic Disease Strongly disagree	Chronic Disease Did Not Attend
Preparedness Update	Preparedness Update Strongly Agree	Preparedness Update Agree	Preparedness Update Not Sure	Preparedness Update Disagree	Preparedness Update Strongly disagree	Preparedness Update Did Not Attend

5. The presentations were over overall high quality:

	Strongly Agree	Agree	Not Sure	Disagree	Strongly Disagree	Did not attend
Falls Prevention (both)	*The presentations were over overall high quality: Falls Prevention (both) Strongly Agree	Falls Prevention (both) Agree	Falls Prevention (both) Not Sure	Falls Prevention (both) Disagree	Falls Prevention (both) Strongly Disagree	Falls Prevention (both) Did not attend
Tobacco Control	Tobacco Control Strongly Agree	Tobacco Control Agree	Tobacco Control Not Sure	Tobacco Control Disagree	Tobacco Control Strongly Disagree	Tobacco Control Did not attend
Chronic Disease	Chronic Disease Strongly Agree	Chronic Disease Agree	Chronic Disease Not Sure	Chronic Disease Disagree	Chronic Disease Strongly Disagree	Chronic Disease Did not attend
Preparedness Update	Preparedness Update Strongly Agree	Preparedness Update Agree	Preparedness Update Not Sure	Preparedness Update Disagree	Preparedness Update Strongly Disagree	Preparedness Update Did not attend

Additional Comments (please specify)

6. As a result of my participation in this session, I will be able to use this knowledge to address similar issues in my community:

	Strongly Agree	Agree	Not Sure	Disagree	Strongly Disagree	Did Not Attend
Falls Prevention (Both)	*As a result of my participation in this session, I will be able to use this knowledge to address similar issues in my community: Falls Prevention (Both) Strongly Agree	Falls Prevention (Both) Agree	Falls Prevention (Both) Not Sure	Falls Prevention (Both) Disagree	Falls Prevention (Both) Strongly Disagree	Falls Prevention (Both) Did Not Attend
Tobacco Control	Tobacco Control Strongly Agree	Tobacco Control Agree	Tobacco Control Not Sure	Tobacco Control Disagree	Tobacco Control Strongly Disagree	Tobacco Control Did Not Attend
Chronic Disease	Chronic Disease Strongly Agree	Chronic Disease Agree	Chronic Disease Not Sure	Chronic Disease Disagree	Chronic Disease Strongly Disagree	Chronic Disease Did Not Attend
Preparedness Update	Preparedness Update Strongly Agree	Preparedness Update Agree	Preparedness Update Not Sure	Preparedness Update Disagree	Preparedness Update Strongly Disagree	Preparedness Update Did Not Attend

7. The knowledge gained from this program will help me perform my job more effectively:

	Strongly Agree	Agree	Not Sure	Disagree	Strongly Disagree	Did Not Attend
Falls Prevention (both)	*The knowledge gained from this program will help me perform my job more effectively: Falls Prevention (both) Strongly Agree	Falls Prevention (both) Agree	Falls Prevention (both) Not Sure	Falls Prevention (both) Disagree	Falls Prevention (both) Strongly Disagree	Falls Prevention (both) Did Not Attend
Tobacco Control	Tobacco Control Strongly Agree	Tobacco Control Agree	Tobacco Control Not Sure	Tobacco Control Disagree	Tobacco Control Strongly Disagree	Tobacco Control Did Not Attend
Chronic Disease	Chronic Disease Strongly Agree	Chronic Disease Agree	Chronic Disease Not Sure	Chronic Disease Disagree	Chronic Disease Strongly Disagree	Chronic Disease Did Not Attend
Preparedness Update	Preparedness Update Strongly Agree	Preparedness Update Agree	Preparedness Update Not Sure	Preparedness Update Disagree	Preparedness Update Strongly Disagree	Preparedness Update Did Not Attend

Other (please specify)

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