Pacific Health & Safety Service Evaluation

Please enter the location where you received your training or service?

my worksite

community room

church

school

name of location

How did you hear about our services?

What type of course or service did you receive?

How do we rate on the following attributes?

	Well Below Average	Below Average	Average	Above Average	Well Above Average	N/A
clarity of information presented

efficiency and effectiveness of presenter(s)

inclusion of skills you needed

quality of written course materials provided

delivery of service

professionalism

convenience of time and location

overall satisfaction



After this couse, do you feel confident to identify an emergency

do you feel prepared to respond to an emergency

do you feel willing to act in an emergency

Did you take this course for

certification for job

school

volunteering requirement

desire to help save lives in community

help family member(s)

Other

The cost of this course/service is

reasonable

expensive

inexpensive

did not pay

Was your course a

Full Course

Review Course

Challenge Course

Other

Do you have any suggestions for improvement?

What is your gender?

Male

Female

Prefer not to answer

What is your age?

What best describes your employment status?

Which of the following categories best describes you?