Last Modified: 06/15/2023
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.
NCHAM Statewide Evaluation Tools
Hospital Surveys and Evaluation Tools
- MA Report Card Template [PDF]
- Wisconsin Hospital Survey [PDF]
- Survey of Hospitals [PDF]
- Kentucky Hospital Survey [PDF]
- Massachusetts NHS Survey [PDF]
- Michigan UNHS Hospital Rating Form [PDF]
Audiology/Diagnostic Center Surveys
- Arizona Survey on Pediatric Audiology Services [PDF]
- Wisconsin Survey on Pediatric Audiology Services [PDF]
- Utah Department of Health Audiologist Questionnaire [PDF]
- Audiologist Survey [PDF]
- Idaho Audiology Survey [PDF]
Early Intervention Program Activities Surveys
Parent & Family Surveys
- Ohio Parent Survey of Screening Activities [PDF]
- Ohio Parent Survey of Early Intervention Activities [PDF]
- Parent Survey (Rhode Island) [PDF]
- Parent Survey (Eiserman) [PDF]
