Form Approved
OMB No. 0920-0847
Exp. Date 02/28/2013 Public reporting burden of this collection of information is estimated to be 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information, unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30033; Attn: PRA (0920-0847).
Please answer all questions as indicated.
1. How many years experience do you have with violence prevention?
What area of violence prevention do you have experience with (choose all that apply)?
Which of the following agencies/categories best describes where you work?
What is your current job title? Please specify.
This product will change the way I work to prevent violence. | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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This product will improve the way I work to prevent violence. | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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I plan on using this product in a training. | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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This product is engaging and holds my interest.
| Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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This product contains credible information. | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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This product is well organized. | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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This product is easy to understand.
| Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | Not Applicable |
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The utilization of this product has led to concrete changes in the programs or services provided by my organization.
| Never | Rarely | Sometimes | Often | Very Often | Not Applicable |
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Is there anything that would keep you from using this product?
Would you recommend this product to others?
What was most useful about this product?
What was least useful about this product?
Is there anything you would like to know that this product does not tell you?
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