Program Evaluation Tools

As more and more statewide EHDI programs have been implemented, the importance of program evaluation and quality assurance activities are increasingly recognized. Many of these activities require the collection of data from the various stakeholders in EHDI programs. Examples of questionnaires, surveys, and checklists which have been used by others are included on this page. You are free to use this material, adapting it to fit your own circumstances, in or working to improve the EHDI program in your area.

Program evaluation tools categories:

• NCHAM Statewide Evaluation Tools
• Hospital Surveys and Evaluation Tools
• Audiologist/Diagnostic Center Surveys
• Early Intervention Program Activities Surveys
• Parent & Family Reactions to EHDI Program Activities Surveys
• General EHDI Surveys

NCHAM Statewide Evaluation Tools

• Parent Refer Survey
  File Type: PDF
  File Size: > 0.1 MB
  
  
• Parent Pass Survey
  File Type: PDF
  File Size: > 0.1 MB
  
  
• Hospital Survey
  File Type: PDF
  File Size: > 0.1 MB
  
  
• Physician Survey
  File Type: PDF
  File Size: 0.50 MB
  
  

Hospital Surveys and Evaluation Tools

• Wisconsin Hospital Survey
  File Type: PDF
  File Size: 0.14 MB
  
  
• Newborn Hearing Screening Survey from Colorado »
  
  
• Survey of Hospitals
  File Type: PDF
  File Size: 0.23 MB
  
  
• Kentucky Hospital Survey
  File Type: PDF
  File Size:0.21 MB
  
  
• Massachusetts NHS Survey
  File Type: PDF
  File Size: 0.29 MB
  
  
• Michigan UNHS Hospital Rating Form
  File Type: PDF
  File Size: > 0.1 MB
  
  

Audiology/Diagnostic Center Surveys

• Arizona Survey on Pediatric Audiology Services
  File Type: PDF
  File Size: > 0.1 MB
  
  
• Colorado Survey of Pediatric Audiology Services »
  
  
• Wisconsin Survey on Pediatric Audiology Services
  File Type: PDF
  File Size: > 0.1 MB
  
  
• Utah Department of Health Audiologist Questionnaire
  File Type: PDF
  File Size: 0.20 MB
  
  
• Audiologist Survey
  File Type: PDF
  File Size: 0.23 MB
  
  
• Idaho Audiology Survey
  File Type: PDF
  File Size: 0.21 MB
  
  

Early Intervention Program Activities Surveys

• Standards for an Early Intervention Program
  File Type: PDF
  File Size: 0.14 MB
  
  
• Colorado Early Intervention Survey
  
  
• Ohio Early Intervention Survey
  File Type: PDF
  File Size: 0.15 MB
  
  

Parent & Family Surveys

• Ohio Parent Survey of Screening Activities
  File Type: PDF
  File Size: 0.18 MB
  
  
• Ohio Parent Survey of Early Intervention Activities
  File Type: PDF
  File Size: 0.19 MB
  
  
• Parent Survey (Rhode Island)
  File Type: PDF
  File Size: > 0.1 MB
  
  
• Parent Survey (Eiserman)
  File Type: PDF
  File Size: 0.14 MB
  
  

General EHDI Surveys

• Idaho EHDI Needs Assessment For Further Information or Training
  File Type: PDF
  File Size: 0.14 MB
  
  
• Idaho EHDI Grant Application Evaluation Form
  File Type: PDF
  File Size: > 0.1 MB