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US Coast Guard Command Instructions
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Four level Evaluation Model (KIRKPATRICK)
Trainee Survey Form
Training Evaluation Policy - index
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Encl:
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COMDTINST
1550.23
Trainee
Survey
General
Within
the
last
year,
you
attended
training
indicated
on
the
attached
survey
form.
The
training
was
designed
to
give
you
skills
and
knowledge
required
to do
your
job.
This
survey
asks
questions
to
help
determine
how
valuable
that
training
really
was in
helping
you
do
your
job
at
your
unit.
Please
take a
few
minutes
to
complete
and
return
this
survey.
Your
input
will
help
us make sure
that
the
training
is
meeting
your
needs.
Section
I:
Task
List
Instructions:
Read
each
statement
and
indicate
YES
- if
you
perform
the
task in
your
job
or
NO
-
if
you
do
not
perform
the
task in
your
job.
If
yes,
please
indicate
your
confidence
level
in
performing
the
tasks. If
you
answered
no,
do
not
rate
the
confidence
level.
Section
II:
Training
Benefit
Instructions:
Please
mark
the
most
appropriate
answer.
1.
Training
provided
complete
knowledge/skills to
proficiently
perform
the
task.
Mark
this
answer
if
you
were
able to
leave
the
training
and
perform
the
task at
your
unit
without
any
further
on-the-job
training
or
practice.
2.
Training
provided
a
strong
base
to
proficiently
performing
the
task.
Mark
this
answer
if
training
gave
you
a
strong
base
and was
supplemented
on
the
job
with
further
training
or
practice.
3.
Training
was
of
little
or no
benefit
to
proficiently
performing
the
task.
Mark
this
answer
if
your
training
did
not
provide
the
skills/
knowledge
to get started on
the
task or if
the
training
you
received
was
outdated
or
different
from
the
actual
duties
required
to
perform
the
task.
In
other
words,
you
had to
completely
learn
how
to do
this
task on
the
job.
4.
Task
is
performed
at
unit,
but
my
duties
do not
require
me to
complete
this
task.
Mark
this
answer
if
the
task is
performed
at
your
unit
but
you
are
not
required
to do
the
task.
5.
Task
not
performed
by
anyone
at this
unit.
Section
III: Comments
Please
use
this
section
to
identify
any
tasks
you
would
like
to
have
seen
in
the
course or
anything
that
keeps
you
from
becoming
proficient
in
the
tasks
associated
with
the
training.
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