Survey to Evaluate the Checklist for Temporary, Satellite, or Off-site Vaccination Clinics

The goal of the NAIIS checklist is to achieve consistency across all vaccination clinics held at temporary, satellite, or off-site locations so that each clinic utilizes best practices for vaccine shipment, transport, storage, handling, preparation, administration, and documentation. We need your help to evaluate and improve the checklist. Please take a moment to respond to these questions. The survey should take less than 5 minutes to complete. If you do not understand part of the survey, or if you have follow-up questions or comments, please email checklist@izsummitpartners.org. Thank you!

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* 1. At approximately what proportion of vaccination clinics that you held did you utilize the checklist?

Every Clinic

Most Clinics

Some Clinics

No Clinics

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* 2. If you did not use the checklist at every clinic, what prevented you from doing so? (check all that apply)

Our organization was not aware of the checklist until after clinics had begun

Our organization did not support using the checklist

The checklist was too complicated

The checklist was too long

Our organization would not have been able to complete the checklist without marking at least one stop sign

Other (please specify):

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* 3. In general, at each clinic you held, how many items on the checklist were you unable to fill in an answer choice with a Y, N, or NA response?

Unable to answer any items on the checklist

Unable to answer most of the items on the checklist

Unable to answer some of the items on the checklist

Able to answer all of the items on the checklist

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* 4. Were there items on the checklist that you did not understand?

Yes

If "Yes", which item(s) did you not understand? And what would make it/ them easier to understand?

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* 5. In general, at each clinic you held, how many items were achievable?

All items on the checklist were achievable

Most of the items on the checklist were achievable

Some of the items on the checklist were achievable

None of the items on the checklist were achievable

What was not achievable and why?

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* 6. Are there any important elements of holding a vaccination clinic at a temporary, satellite, or off-site location that were not covered in the checklist that should have been included?

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* 7. Did you distribute the checklist to any other organizations or groups that hold temporary, satellite, or off-site vaccination clinics?

Yes

If "Yes", to how many groups did you distribute the checklist? And to which groups did you distribute the checklist?

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* 8. If you used this checklist at a clinic, how useful was it? (star rating out of 4 stars)

The checklist was extremely difficult to follow and the guidance was not useful

The checklist was somewhat difficult to follow and the guidance was mostly not useful

The checklist was mostly easy to follow and the majority of the guidance was useful

The checklist was very easy to follow and the guidance was useful

The checklist was extremely difficult to follow and the guidance was not useful

The checklist was somewhat difficult to follow and the guidance was mostly not useful

The checklist was mostly easy to follow and the majority of the guidance was useful

The checklist was very easy to follow and the guidance was useful

Additional feedback or explanation of star rating:

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* 9. Do you have any additional comments about the checklist or suggestions to improve the checklist?

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* 10. How did you hear about the checklist (select all that apply)

State or local health department

Immunization Action Coalition

Association of Immunization Managers

CDC Website link

Friend/ colleague in public health

Internet

National Adult and Influenza Immunization Summit

Don't know

Other (please specify)

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* 11. Which of the following best describes your organization

Hospital or health system

School, college, or university

Public Health Department

Occupational health clinic

Travel medicine clinic

Other (please specify):

Survey to Evaluate the Checklist for Temporary, Satellite, or Off-site Vaccination Clinics

Question Title

* 1. At approximately what proportion of vaccination clinics that you held did you utilize the checklist?

Question Title

* 2. If you did not use the checklist at every clinic, what prevented you from doing so? (check all that apply)

Question Title

* 3. In general, at each clinic you held, how many items on the checklist were you unable to fill in an answer choice with a Y, N, or NA response?

Question Title

* 4. Were there items on the checklist that you did not understand?

Question Title

* 5. In general, at each clinic you held, how many items were achievable?

Question Title

* 6. Are there any important elements of holding a vaccination clinic at a temporary, satellite, or off-site location that were not covered in the checklist that should have been included?

Question Title

* 7. Did you distribute the checklist to any other organizations or groups that hold temporary, satellite, or off-site vaccination clinics?

Question Title

* 8. If you used this checklist at a clinic, how useful was it? (star rating out of 4 stars)

Question Title

* 9. Do you have any additional comments about the checklist or suggestions to improve the checklist?

Question Title

* 10. How did you hear about the checklist (select all that apply)

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* 11. Which of the following best describes your organization

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* 12. Name (optional):

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* 13. Email address (optional):