Site Surveyor Peer Evaluation Form

This is your opportunity to reflect on the performance of the site surveyor team member with whom you were paired. This peer evaluation will remain confidential within the MAERB subcommittee focused on Surveyor training, so please be honest in your responses. This evaluation process will help to ensure that each surveyor’s performance is reviewed; each surveyor will be notified of strengths and/or areas that can be improved upon.

* 1. Please fill out the following:

* 2. INSTRUCTIONS: For the area of PLANNING & PREPARATION, consider each item separately and rate each item independently. Indicate the rating that illustrates the extent to which you agree with each statement.

  Strongly Agree Mostly Strongly Agree Agree Sometimes Disagree Strongly Disagree
Partner was accessible and prompt in making travel arrangements and participating in other pre-visit arrangements.
Partner was available to discuss the self-study report at the arranged time (phone/night before) prior to the visit.
Partner was well-prepared at the time of the visit, having reviewed the self-study and supporting materials.

* 3. INSTRUCTIONS: For the area of PROFESSIONALISM & OBJECTIVITY, consider each item separately and rate each item independently. Indicate the rating that illustrates the extent to which you agree with each statement.

  Strongly Agree Mostly Strongly Agree Agree Sometimes Disagree Strongly Disagree
Partner was a professional, credible, and positive representative of CAAHEP and MAERB.
Partner demonstrated tact and sensitivity.
Partner modeled professional integrity.
Partner was prompt and well-prepared for scheduled meetings during the site visit.
Partner communicated well and respectfully with the Communities of Interest at the site visit, encouraging an open, honest, and non-threatening atmosphere.
Partner maintained confidentiality and practiced discretion.
Partner was objective and fair in evaluating the program.
Partner did NOT impose personal values, philosophies, prescriptive preferences, or biases.

* 4. INSTRUCTIONS: For the area of PROGRAMMATIC & ACCREDITATION KNOWLEDGE, consider each item separately and rate each item independently of all others. Indicate the rating that illustrates the extent to which you agree with each statement.

  Strongly Agree Mostly Strongly Agree Agree Sometimes Disagree Strongly Disagree
Partner was knowledgeable of the Standards, guidelines, and CAAHEP/MAERB policies.
Partner had the appropriate expertise in the areas of medical assisting education/practice.
Partner was able to effectively evaluate the documentation that the program provided.
Partner asked appropriate questions, tailoring them for the specific groups.
Partner demonstrated an understanding of the site survey process.

* 5. It would be very helpful if you would add some comments to further elaborate your ratings of your partner in the following areas: Planning & Preparation; Professionalism & Objectivity; and Programmatic & Accreditation knowledge. For example, what advice would you give your partner for further success in any of these areas? What was a particular strength that you noted? What area could use more improvement?

* 6. If the person being reviewed is the Team Member, would you recommend this individual to serve as a Team Coordinator on subsequent site visits?

* 7. If the person being reviewed is the Team Coordinator, would you recommend this individual to serve as a Team Coordinator on subsequent site visits?

* 8. INSTRUCTIONS: Please provide your feedback of the support that was offered by the MAERB office as you were preparing for the site survey.

  Strongly Agree Mostly Strongly Agree Agree Sometimes Disagree Strongly Disagree N/A
The MAERB office provided you with clear instructions about the stages of the visit.
The MAERB office provided you with up-to-date information about new policies and shifts in practice.
The MAERB office responded promptly and helpfully to any additional requests for help or information via email or phone.

* 9. MAERB is now using a travel agency in order to streamline the travel process for the MAERB Surveyors. The goal in using this service is to better coordinate travel, to ensure that travel arrangements are made well in advance of the site visit, to reduce the financial outlay for the surveyors by having MAERB pay for the airfare in advance, and, ultimately, to save money for the programs.

As this is a new relationship, we would appreciate your feedback so that we can best work with the travel agency. With that in mind, could you please rank the travel agency on a scale from 1-5, focused on accessibility and ease of use.

  Very Easy to Use Generally Very Easy to Use Easy to Use Occasionally Not Easy to Use Not Easy to Use
Contacting and getting a response from Foremost Travel
Booking of airline travel
Booking of hotel

* 10. What additional comments would you make about the service of Foremost Travel Agency? Let us know about your experience, as this will be feedback that MAERB gives to the travel agency.

* 11. INSTRUCTIONS: Please provide your feedback of the new resources that the MAERB is providing to the Program Directors and to the Site Surveyors. 

  Strongly Agree Mostly Strongly Agree Agree Sometimes Disagree Strongly Disagree N/A
The design of the Self-Study Report helped you to understand the specific medical assisting program and helped you to ensure that the program was complying with the Standards and Guidelines.  
The Program Director clearly and effectively organized the electronic materials required onsite based upon the handout "Documents for On-Site Review and Document Checklist, 2015."  
The Onsite Survey Report (word version) allows you to clearly indicate the program's level of compliance with the Standards, and the instructions are clear.  
The Onsite Survey Report (excel workbooks--curricular) is designed to help you understand what to examine and what to report.  
You received helpful tips from the MAERB office in putting together the final report.

* 12. Please sign your name below in order for the Accreditation Department to contact you with any questions if applicable.

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