Thank you for completing the ISDH training module on how to enter a new incident into the Indiana trauma registry. Completing this survey will verify that you have completed the training and to address any follow-up questions you may have.

* 1. Your Name:

* 2. The facility name that you are entering data for (please list all the facilities if you are entering for multiple hospitals):

* 3. Your email address:

* 4. Your phone number:

* 5. Was this training helpful?

* 6. Please provide any feedback on the training:

Thank you for taking the time to fill out this survey. Your feedback will be used to improve the training material for the trauma registry.

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