Feedback and Evaluation

Emergency Response Training Programs and Products

Thanks for taking an EMS Safety certification course. We appreciate your feedback on the Instructor, course materials, and course environment. Your comments will be sent to EMS Safety Services, Inc. and the course Instructor. Enter the Instructor number in the area below and verify the Instructor name. Thank you for your time and consideration.

Instructor's number:

If you do not know the Instructor's number, please type "UNKNOWN" in the 'Instructor Number' box above, then type your Instructor's name.

Reason you took the course:

Personal knowledge

Work

Type of Course: Check all that apply
CPR	First Aid
Bloodborn Pathogens	AED
Professional Rescuer CPR/AED	Oxygen Administration
Other:
Date of Course YY-MM-DD - -

INSTRUCTOR	Excellent	Good	Fair	Below Average	Poor
Professionalism
Organization
Subject knowledge
Helpfulness
Fairness
Presentation ability

Do you feel adequately prepared to use your new skills when needed? Explain.

What did you like most about this course?

What did you like least about this course?

What would you like to see added to the course?

Would you take another course from this Instructor? Explain.

Additional Comments:

CONTACT INFORMATION (OPTIONAL)
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COURSE MATERIALS	Excellent	Good	Fair	Below Average	Poor
Student Workbook
Training Video

COURSE CONTENT	Excellent	Good	Fair	Below Average	Poor
Comprehensive
Met my training needs
Time spent practicing skills

COURSE FACILITIES	Excellent	Good	Fair	Below Average	Poor
Amount of practice equipment
Condition of practice equipment
Facility comfort
Enough room for practice