1 Start 2 Complete Activity Title: * Activity Date: * Speaker/Presenter Name(s): * Disclosure: Was disclosure communicated to audience? * Yes No Did you reach your intended target audience? * Yes No If you did not reach your intended target audience, please explain: Was there bias present? * yes No If there was bias, please describe: Summarize from the evaluation responses the most common things the audience intends to incorporate into their practice? * Additional test area: What barriers to implementation were identified? * Looking at the evaluation data, did this program meet your intended goals and objectives? * Yes No If this program did not meet your intended goals and objectives, describe your next action: The following information is being gathered for tracking purposes only: Were cases discussed? * Yes No Was this related to a quality initiative? * Yes No Which? Did it address communication issues? * Yes No Describe: Did it address improving collegiality? * Yes No Explain: Program Planner's Name and Contact Number * Date: * Leave this field blank
