April 2015
Kirkpatrick Level 3 Evaluation Questionnaire
Free download from: Workplacekarma.Wordpress.com
Kirkpatrick’s Level 3 Evaluation Questionnaire
Apr 2015
Kirkpatrick’s Level 3 Evaluation Questionnaire How to use this document This questionnaire is divided into 2 sections: · The first section is a feedback questionnaire to be sent to all training participants six weeks after training completion. · The second section should be sent to all training participants ONE YEAR after training completion. · The participant’s Supervisor/ Manager can also be requested to provide information for their team member. · Discrepancies in the information received from the participant and their Supervisor can be analyzed to identify overview trends in return of investment recognized by the organization from the training.
Downloaded from: WorkplaceKarma.Wordpress.com
Page 1 of 6
Kirkpatrick’s Level 3 Evaluation Questionnaire
Apr 2015
Feedback Questionnaire Sent Six Weeks after Training 1.
What was the most useful session of the training?
2.
Have you shared the information from the training with your colleagues? If yes, please describe how.
3.
Have you incorporated aspects of the protocols into your planning and/or emergency preparedness plans? If yes, please describe how.
4.
Do you need additional technical advice or information on any of the topics discussed during the training?
5.
Have you read or used the documents provided during the training? if yes, which documents?
6.
Do you need additional technical support?
Name of Training Participant: Date, Location: Current Position in Organization: Position at the time of attending Training:
Downloaded from: WorkplaceKarma.Wordpress.com
Page 2 of 6
Kirkpatrick’s Level 3 Evaluation Questionnaire
Apr 2015
Self-Assessment Questionnaire of Abilities, Strengths and Needs One Year after Training For column A (Current Ability): ·
4 = above average compared to your ability in other areas
·
3 = average or moderate
·
2 = Minimal ability
·
1 = no experience or training in this area
For column B (Importance at Work): ·
5 = Critical importance – a key developmental objective
·
4 = very important
·
3 = average or moderate importance
·
2 = Minimal importance
·
1 = no importance
Domains and competencies
A (Current
B (Importance
C (B minus A)
Ability)
at Work)
Skills Gap
(1) Methodology 1.1 conduct field investigations 1.2 analyze and interpret data by person, place and 1.3 design and conduct a survey 1.4 design and conduct case-control and cohort 1.5 collect, package, store and transport specimens to the laboratory 1.6 interpret results of laboratory tests 1.7 describe the laboratory tests used for diagnosis of diseases under surveillance 1.8 screen and recruit subjects as per study protocol 1.9 store and prepare investigational product (2) Communication 2.1 prepare and deliver an oral scientific presentation 2.2 prepare a scientific manuscript for a peer-reviewed journal 2.3 prepare an abstract for a peer-reviewed journal 2.4 prepare and present a poster presentation for a scientific meeting 2.5 prepare reports for presentation to decisionmakers and policy- makers
Downloaded from: WorkplaceKarma.Wordpress.com
Page 3 of 6
Kirkpatrick’s Level 3 Evaluation Questionnaire
Apr 2015
2.6 prepare statements for the public, using a variety of media, in response to public health issues 2.7 use appropriate interpersonal communication skills to enable efficient leadership in the public health community (3) Technology 3.1 describe the components of a computer/ iPad 3.2 use systems to manage studies- CTMS, EDC, 3.3 use a word processor to prepare scientific documents and reports 3.4 use spreadsheet to organize epidemiological and financial data (4) Management and Leadership 4.1 manage a clinical study 4.2 manage AEs and SAEs 4.3 perform financial planning and budgetary 4.4 manage personal responsibilities such as priorities, time and information 4.5 create an environment that supports group participation and interaction 4.6 communicate effectively with other health professionals, such as laboratory personnel 4.7 facilitate and document training sessions 4.8 develop instructional materials and presentations
Downloaded from: WorkplaceKarma.Wordpress.com
Page 4 of 6
Kirkpatrick’s Level 3 Evaluation Questionnaire
Apr 2015
For each white row, check the applicable item shown in grey. No
No
Some
Moderate
Signifi-
Very
opportunity
change
change
change
cant
significant
change
change
to apply
a. Organizing 1. prioritizing daily activities 2. applying creative techniques 3. organizing daily activities 4. raising level of performance standards in area of responsibility b. Impact at Work 1. applying coaching 2. applying techniques/ initiatives that influence motivation 3. implementing job enrichment opportunities 4. implementing better control and monitoring systems 5. applying techniques that influenced better teamwork c. Personal Outcomes 1. improved written communications 2. improved oral communications 3. greater self-confidence
Downloaded from: WorkplaceKarma.Wordpress.com
Page 5 of 6
Kirkpatrick’s Level 3 Evaluation Questionnaire
Apr 2015
Answer the questions that apply. 1.
List the three behaviors or skills from the list above that you have used most frequently as a result of the training.
2.
What has changed about you or your work as a result of your participation in this training? (E.g. specific behavior changes such as: increased delegation to employees, improved communication with patients, employee participation in decision-making, improved problemsolving.)
3.
In what ways were you unprepared for field activities?
4.
What barriers, if any, have you encountered that have prevented you from using skills/behaviors gained in the training? Check/tick all that apply. a. I have had no opportunity to use the skills b. I have not had enough time to apply the skills c.
My work environment is not appropriate for the use of these skills/behaviors
d. My supervisor does not support this type of program e. Other (please specify): f. 5.
If any of the above are checked, please explain if possible:
What additional support could be provided by management that would influence your ability to apply the skills and knowledge learned from the program?
6.
Would you recommend the training program to others? m Yes m no please explain. if no, why not? if yes, what groups/jobs and why?
7.
What specific suggestions do you have for improving the training program?
8.
Other comments
Name of Training Participant: Date, Location: Current Position in Organization: Position at the time of attending Training:
Downloaded from: WorkplaceKarma.Wordpress.com
Page 6 of 6