CATRAC Stop the Bleed Class Evaluation Form
Please fill out carefully in order to receive certificate
Student name
*
First Name
Last Name
Email
*
Organization
County of residence
*
Zip code of residence
*
Gender
*
Please Select
Female
Male
Trans-Woman
Trans-Male
Non-binary
Agender
Gender nonconforming
Rather not say
Other
Please Select the Gender you Identify Most With
Select your age range
*
Please Select
Under 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65+
Date of training
*
Training location
*
Please Select
CATRAC
Camp Swift
St. David's Medical Center
City of Austin
Lago Vista High School
Barbara Jordan State Building Capitol Complex, Austin
Tesla, Inc.
ERS State Office Building Capitol Complex
TDEM
PDC
Instructor
*
Please Select
Rhonda Manor-Coombes
Kiara Roe
Rachel Lindsay
Rusty Wood
Courtney Meyer
Shannon Koesterer
Greg Johnston
Charles Garner
Victor Taylor
Curtis Murphy
Michelle Schwake
Richard Slaughter
Sarah Leach
Billy Atkins
Payton Bowyer
Mandy Paul
Allegra Cappuccini
Jonathan Barber
Mark Marshall
Mike Moning
Nate Rasmussen
Thomas McClure
Adam Phillips
Adrian Castillo
Brooke Dahl
Tracie Schuh
Thomas Kinney
Keith Hughart
Bertha Cavazos
Rayse Richardson
Brian Rozmus
Kevin Carollo
Kristen Hullum
Dennis Grelis
Second instructor (if applicable)
Please Select
Rhonda Manor-Coombes
Kiara Roe
Katherine Contreras
Rachel Lindsay
Rusty Wood
Courtney Meyer
Shannon Koesterer
Greg Johnston
Charles Garner
Victor Taylor
Sarah Leach
Billy Atkins
Payton Bowyer
Mandy Paul
Allegra Cappuccini
Jonathan Barber
Mark Marshall
Mike Moning
Nate Rasmussen
Thomas McClure
Adam Phillips
Adrian Castillo
Brooke Dahl
Tracie Schuh
Thomas Kinney
Keith Hughart
Raul Escamilla
Bertha Cavazos
Rayse Richardson
Brian Rozmus
Kevin Carollo
Kristen Hullum
Dennis Grelis
Have you previously participated in a Stop the Bleed course?
*
Yes
No
After completing this training, do you feel more confident you could help someone who is severely bleeding?
*
Yes, I feel more confident after participating in this training.
No, I do not feel confident after participating in this training.
No change. I felt confident helping before taking this training.
No change. Nothing could make me confident to respond to severe bleeding.
Please answer the following questions about your instructor
Provided instruction and help during my skills practice session.
*
Yes
No
Answered all of my questions.
*
Yes
No
Was professional and courteous to the students.
*
Yes
No
Please answer the following questions about the course content
The course learning objectives were clear.
*
Yes
No
The overall level of difficulty of the course was:
*
Too hard
Too easy
Appropriate
The content was presented clearly.
*
Yes
No
The quality of videos and written materials was:
*
Excellent
Good
Fair
Poor
The equipment was clean and in good working condition.
*
Yes
No
Please answer the following questions about your skill mastery
The course prepared me to successfully pass the skills section.
*
Yes
No
I am confident I can use the skills the course taught me.
*
Yes
No
Unsure
I will respond in an emergency because of the skills I have learned in this course.
*
Yes
No
Not sure
I took this course to obtain professional credit or continuing education credit.
*
Yes
No
Optional Questions:
If you previously taken this course via another method, such as in a classroom or online? Which learning method do you prefer and why?
Were there any strengths or weaknesses of the course that you would like to comment on?
What would you like to see in the future courses developed by CATRAC?
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Instructor Name
Training Location
Ex. CATRAC
2nd Instructor (only answer if applicable)
Leave blank if there was not a 2nd instructor
Type a question
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