The following survey has been developed to evaluate your clinical placement and will take 10 minutes to complete.

There are two sections to this survey. In the first part there are questions about your experience at your clinical placement. In the second part you will need to identify how confident you feel now in performing certain skills.

The information that you identify will assist in improving the clinical placements in the Maternity Connect Program. The responses to this survey may form part of the evaluation of the program, however the data will be reported as a group response and will not be individually identified.

Thank you for your participation in this survey.

Kylie Martin
Maternity Connect Program Manager

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* 1. Midwife/Nurse's Name

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* 2. What Health Service are you from?

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* 3. Where is your Health Service located?

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* 4. Where was your placement facilitated?

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* 5. Where did you complete your placement?

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20% of survey complete.