CoH Safe Sleep Quiz Survey

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* 1. Client Name

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* 2. Agency who gave you the crib

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* 3. How clearly did your instructor explain the goals of this training?

Very clearly

Somewhat clearly

Not so clearly

Not at all clearly

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* 4. Fill in the blank: The ABC's of safe sleep teaches us that baby should be __________ in the crib!

placed on a pillow

alone

with another baby

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* 5. Fill in the blank: The ABC's of safe sleep teaches us that baby should always be put to sleep on his/her __________.

tummy

side

back

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* 6. Fill in the blank: The ABC's of safe sleep teaches us that baby should only sleep in a safety approved __________ or bassinet.

crib

baby swing

couch

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* 7. Do you feel prepared to talk to others, who are caring for your baby, about the ABC's of safe sleep?

Very confident

Somewhat confident

Not so confident

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* 8. How often will you place your baby on his/her back when he/she sleeps?

All the time

Sometimes

Not at all

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* 9. Fill in the blank: A SleepSack is a safe alternative to a _____________.

baby swing

car seat

blanket

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* 10. When using a SleepSack I must...

always put a blanket on top of my baby to make sure he/she is warm.

make sure baby is swaddled but when baby can roll over I need to make sure baby's arms stick out.

attach baby's pacifier to it using a string.

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* 11. The risk of SIDS can be lowered AND Accidental Suffocation & Strangulation in Bed can be prevented if you practice the following: (select all that apply)

The ABC's of Safe Sleep

Tummy Time

Breastfeeding

Using a Pacifier

No Smoking

No Overheating

Room Sharing NOT Bed Sharing

All of the above

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* 12. I feel confident in setting up and taking down my baby's portable crib because I'll remember:

Pop, Lock, and Drop

Pop goes the weasel

Stop, Drop, and Roll

My own method

I don't know

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* 13. Information was presented in a manner that was easy to understand and remember?

All

Some

None

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* 14. Did your instructor present materials and information too fast, too slow, or just right?

Too fast

Too slow

Just right

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* 15. Why were you taking this training? (select all that apply)

I needed a portable crib and this was a requirement.

I was supporting my spouse, friend, daughter, significant other, etc.

I wanted to learn more about safe sleep education.

This training was offered to my community group (school, church, girl/boy scouts, "MOPS", child care program etc.)

I will be providing safe sleep training/education to my clients.

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* 16. How likely is it that you would recommend this training to others?

NOT AT ALL LIKELY

EXTREMELY LIKELY

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* 1. Client Name

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* 2. Agency who gave you the crib

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* 3. How clearly did your instructor explain the goals of this training?

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* 4. Fill in the blank: The ABC's of safe sleep teaches us that baby should be __________ in the crib!

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* 5. Fill in the blank: The ABC's of safe sleep teaches us that baby should always be put to sleep on his/her __________.

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* 6. Fill in the blank: The ABC's of safe sleep teaches us that baby should only sleep in a safety approved __________ or bassinet.

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* 7. Do you feel prepared to talk to others, who are caring for your baby, about the ABC's of safe sleep?

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* 8. How often will you place your baby on his/her back when he/she sleeps?

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* 9. Fill in the blank: A SleepSack is a safe alternative to a _____________.

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* 10. When using a SleepSack I must...

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* 11. The risk of SIDS can be lowered AND Accidental Suffocation & Strangulation in Bed can be prevented if you practice the following: (select all that apply)

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* 12. I feel confident in setting up and taking down my baby's portable crib because I'll remember:

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* 13. Information was presented in a manner that was easy to understand and remember?

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* 14. Did your instructor present materials and information too fast, too slow, or just right?

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* 15. Why were you taking this training? (select all that apply)

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* 16. How likely is it that you would recommend this training to others?

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* 17. What did you like best about this training? Any ideas for how this training could be improved?