Workplace consultation services >> Consultation evaluation form

Workplace consultation evaluation form

 

Please fill in the following information about your THCU consultation experience, to help us ensure that we have met, and continue to meet, the needs of our clients..

Name:
Name of Organization or Group:
Address:
City:
Telephone:
Fax:
E-mail:
Approximate date of consultation

Briefly explain the topic that the consultation focused on.

1. Was this your first THCU consultation?

Yes, this was my first experience with a THCU consultation.

No, I have had previous THCU consultations.

2. What organization were you representing at the time of the consultation?

A board of health or public health unit/department

Community coalition - Focus

A heart health coalition

A community coalition - other

OHPRS member

Another provincial resource centre (supported by the Ontario Ministry of Health)

A community health centre

NGO/voluntary group (e.g. Heart and Stroke, Cancer Society, etc)

Local government

A hospital

Medical Professional

Workplace

School Board

Other (please specify)

3. Please describe your role within your organization at the time of the consultation (Please check all that apply).

health promoter/educator

public health nurse

nutritionist/dietician

public health inspector

manager/supervisor

other (please specify)

4. Which consultant/s did you work with? (please check all that apply).

Larry Hershfield

Brian Hyndman

Nancy Dubois

Jodi Thesenvitz

Other - please specify

5. What do you feel, was the overall quality of the consultation service?

Very Poor

Poor

Average

Good

Excellent

6. How would you rate the materials and tools that were provided as a part of the consultation service?

Very Poor

Poor

Average

Good

Excellent

7. How would you describe your experience of trying to access THCU’s consultation service?

Very Poor

Poor

Average

Good

Excellent

8. Do you feel that your THCU consultation increased your (or your team’s) knowledge? Please check the box that applies.

Not at all

Some

A great deal

9. Do you feel that your THCU consultation increased your (or your team’s) skills? Please check the box that applies.

Not at all

Some

A great deal

10. Do you feel that your THCU consultation increased your (or your team’s) ability to apply theory? Please check the box that applies.

Not at all

Some

A great deal

11. Do you feel that your THCU consultation provided what was needed to address the issue and/or accomplish your (or your team’s) goal?

No

Somewhat

Yes

12. Please tell us, briefly, what you feel were the most useful parts of your experience with THCU’s consultation service.

 

 

13. Please tell us, briefly, what you feel were the least useful elements of your experience with THCU’s consultation service.

 

 

14. Do you have any additional comments?

 

Skill question 13 + 21 = (our attempt to prevent spam).