Evaluation of the Rural Emergency Medical Communications Demonstration Project (REMCDP)
Grant Team or Member
Date of Encounter
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your Name - optional field
Your Agency
Your County
Name(s) of REMCDP Grant representative(s) you encountered
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REMCDP Grant Team Evaluation
Select the appropriate rating. Each item can be scored from 1 (lowest) up to 5 (highest) - use NA for not applicable for your encounter.
Rows
NA
1
2
3
4
5
Knowledgeable
Quality of Work
Reliability and Dependability
Accountability
Communication
Decision-making Skills
Organizational Skills
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Receptive to Feedback
What are the strengths of the grant team member(s)?
What are the weaknesses of the grant team member(s)?
Please provide any specific feedback in relation to your encounter.
What can this grant team do in order to make this experience better for you and your agency?
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