L1 Survey - Unconscious Bias in the Workplace for Leaders

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* 1. Name:

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* 2. Department

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* 3. Division

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* 4. Current Position

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* 5. Course

LEARNING

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* 6. LEARNING

	Strongly Disagree 1	2	3	4	Strongly Agree 5
I learned new knowledge and/or skills from this training.	I learned new knowledge and/or skills from this training. Strongly Disagree 1	I learned new knowledge and/or skills from this training. 2	I learned new knowledge and/or skills from this training. 3	I learned new knowledge and/or skills from this training. 4	I learned new knowledge and/or skills from this training. Strongly Agree 5

JOB IMPACT

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* 7. JOB IMPACT

	0%	25%	50%	75%	100%
What percent of knowledge and/or skills learned from this training do you estimate you will directly apply to your job?	What percent of knowledge and/or skills learned from this training do you estimate you will directly apply to your job? 0%	What percent of knowledge and/or skills learned from this training do you estimate you will directly apply to your job? 25%	What percent of knowledge and/or skills learned from this training do you estimate you will directly apply to your job? 50%	What percent of knowledge and/or skills learned from this training do you estimate you will directly apply to your job? 75%	What percent of knowledge and/or skills learned from this training do you estimate you will directly apply to your job? 100%

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* 8. JOB IMPACT

	Strongly Disagree 1	2	3	4	Strongly Agree 5
I am eager to get back to work to try what I learned.	I am eager to get back to work to try what I learned. Strongly Disagree 1	I am eager to get back to work to try what I learned. 2	I am eager to get back to work to try what I learned. 3	I am eager to get back to work to try what I learned. 4	I am eager to get back to work to try what I learned. Strongly Agree 5

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* 9. Please provide at least one example of how you will apply this learning.

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* 10. What barriers (if any) may prevent you from applying this learning in your job?
(select all that apply)

Lack of…

Knowing how to apply

Motivation

Opportunity to apply

Incentives

Accountability

Time

Supervisor support

Peer support

Supportive processes

Tools / technologies

No barrier

Other (please specify)

ORGANIZATIONAL ALIGNMENT AND IMPACT

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* 11. This training will have a significant impact on the organizational values, goals,
and/or outcomes referenced in the course:

	Strongly Disagree 1	2	3	4	Strongly Agree 5
#1:Commitment to Excellence: Driving innovation and quality care to maximize outcomes	#1:Commitment to Excellence: Driving innovation and quality care to maximize outcomes Strongly Disagree 1	#1:Commitment to Excellence: Driving innovation and quality care to maximize outcomes 2	#1:Commitment to Excellence: Driving innovation and quality care to maximize outcomes 3	#1:Commitment to Excellence: Driving innovation and quality care to maximize outcomes 4	#1:Commitment to Excellence: Driving innovation and quality care to maximize outcomes Strongly Agree 5
#2:Passionate Advocacy: Standing as champions for children	#2:Passionate Advocacy: Standing as champions for children Strongly Disagree 1	#2:Passionate Advocacy: Standing as champions for children 2	#2:Passionate Advocacy: Standing as champions for children 3	#2:Passionate Advocacy: Standing as champions for children 4	#2:Passionate Advocacy: Standing as champions for children Strongly Agree 5
#3:Selfless Service: Serving others with an enthusiastic spirit	#3:Selfless Service: Serving others with an enthusiastic spirit Strongly Disagree 1	#3:Selfless Service: Serving others with an enthusiastic spirit 2	#3:Selfless Service: Serving others with an enthusiastic spirit 3	#3:Selfless Service: Serving others with an enthusiastic spirit 4	#3:Selfless Service: Serving others with an enthusiastic spirit Strongly Agree 5
#4: Unwavering Integrity: Creating an environment of trust through honesty, transparency and authenticity	#4: Unwavering Integrity: Creating an environment of trust through honesty, transparency and authenticity Strongly Disagree 1	#4: Unwavering Integrity: Creating an environment of trust through honesty, transparency and authenticity 2	#4: Unwavering Integrity: Creating an environment of trust through honesty, transparency and authenticity 3	#4: Unwavering Integrity: Creating an environment of trust through honesty, transparency and authenticity 4	#4: Unwavering Integrity: Creating an environment of trust through honesty, transparency and authenticity Strongly Agree 5

If the training will not impact these outcomes, please explain why:

OVERALL SATISFACTION

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* 12. JOB IMPACT

	Strongly Disagree 1	2	3	4	Strongly Agree 5
Overall, I am satisfied with this training course.	Overall, I am satisfied with this training course. Strongly Disagree 1	Overall, I am satisfied with this training course. 2	Overall, I am satisfied with this training course. 3	Overall, I am satisfied with this training course. 4	Overall, I am satisfied with this training course. Strongly Agree 5

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* 1. Name:

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* 2. Department

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* 3. Division

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* 4. Current Position

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* 5. Course

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* 6. LEARNING

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* 7. JOB IMPACT

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* 8. JOB IMPACT

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* 9. Please provide at least one example of how you will apply this learning.

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* 10. What barriers (if any) may prevent you from applying this learning in your job? (select all that apply) Lack of…

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* 11. This training will have a significant impact on the organizational values, goals, and/or outcomes referenced in the course:

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* 12. JOB IMPACT

* 10. What barriers (if any) may prevent you from applying this learning in your job?
(select all that apply)

Lack of…

* 11. This training will have a significant impact on the organizational values, goals,
and/or outcomes referenced in the course: