REVIVE! Training Evaluation Form

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* 1. Did you attend the Lay Rescuer Training or the Lay Rescuer Training of Trainers?

Lay Rescuer

Lay Rescuer Training of Trainers

Rapid REVIVE!

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* 2. Date of Training

Date

Date

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* 3. Instructor

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* 4. Please rate the following using a scale from 1 (poor) to 5(excellent).

	1	2	3	4	5	N/A
Quality of Training Content	Quality of Training Content 1	Quality of Training Content 2	Quality of Training Content 3	Quality of Training Content 4	Quality of Training Content 5	Quality of Training Content N/A
Satisfaction with Instructor	Satisfaction with Instructor 1	Satisfaction with Instructor 2	Satisfaction with Instructor 3	Satisfaction with Instructor 4	Satisfaction with Instructor 5	Satisfaction with Instructor N/A
Quality of Training Facilities (if the training was virtual, select N/A and go to the next question)	Quality of Training Facilities (if the training was virtual, select N/A and go to the next question) 1	Quality of Training Facilities (if the training was virtual, select N/A and go to the next question) 2	Quality of Training Facilities (if the training was virtual, select N/A and go to the next question) 3	Quality of Training Facilities (if the training was virtual, select N/A and go to the next question) 4	Quality of Training Facilities (if the training was virtual, select N/A and go to the next question) 5	Quality of Training Facilities (if the training was virtual, select N/A and go to the next question) N/A
Quality of Virtual Connection	Quality of Virtual Connection 1	Quality of Virtual Connection 2	Quality of Virtual Connection 3	Quality of Virtual Connection 4	Quality of Virtual Connection 5	Quality of Virtual Connection N/A

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* 5.
Please answer the questions below.

Do you feel comfortable administering Naloxone?

Yes

No

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* 6. Would you like to request additional training?

Yes

No

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* 7. Please share any ideas that would help improve this training.

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* 8. Please provide your email address