CSAT BASELINE TECHNICAL ASSISTANCE SATISFACTION SURVEY
 

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Form Approved 

OMB NO. 0930-0197 

Exp. Date 01/31/2014 

CENTER FOR SUBSTANCE ABUSE TREATMENT 

Public reporting burden for this collection of information is 

estimated to average 10 minutes per response to complete the 

Contact Information Form and this questionnaire. Send comments 

regarding this burden estimate or any other aspect of this 

collection of information to the SAMHSA Reports Clearance 

Officer, Room 7-1045, 1 Choke Cherry Road, Rockville, MD 

20850. An agency may not conduct or sponsor and a person is not 

required to respond to a collection of information unless it 

displays a currently valid OMB control number. The control 

Customer Survey—CSAT Technical Assistance 

Please enter the Personal ID Code you used on the consent form here _____________. 

Date of technical assistance, location (i.e., city, state), and topic will be pre-coded and entered in this area of 

the form. 

Please check here ( ) if you have received this survey in error, (i.e., you did not attend the technical 

assistance listed above) and return the uncompleted survey in the enclosed postage-paid envelope. 

PLEASE BASE YOUR ANSWER ON HOW YOU FEEL 

ABOUT THE SESSION NOW. 

1. How satisfied are you with the overall quality of this technical 

assistance? 

Very 

Satisfied 

1 

Satisfied

2 

Neutral 

3 

Dissatisfied 

4 

Very 

Dissatisfied 

5 

2. How satisfied are you with the quality of the staff leading the 

session? 

1 2 3 4 5 

3. How satisfied are you with the quality of the technical 

assistance materials? 

1 2 3 4 5 

4. Overall, how satisfied are you with your technical assistance 

 experience? 

1 2 3 4 5 

PLEASE INDICATE YOUR AGREEMENT WITH THESE 

STATEMENTS ABOUT THE TECHNICAL ASSISTANCE. 

5. The technical assistance was well organized. 

6.	 The material presented in this session will be useful to me in 

dealing with substance abuse. 

7.	 The staff was knowledgeable about the subject matter. 

8.	 The staff was well prepared for the course. 

9. The staff was receptive to participants Comments and 

 questions. 

10.	 I am currently effective when working in this topic area. 

11. The technical assistance enhanced my skills in this topic area. 

Strongly Strongly 

Agree Agree Neutral Disagree Disagree 

1 2 3 4 5 

1 2 3 4 5 

1 2 3 4 5 

1 2 3 4 5 

1 2 3 4 5 

1 2 3 4 5 

1 2 3 4 5 

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12. The technical assistance was relevant to my career. 1 2 3 4 5 

13. I expect to use the information gained from this technical 1 2 3 4 5 

assistance. 

14. I expect this technical assistance to benefit my clients. 1 2 3 4 5 

Strongly Strongly 

Agree Agree Neutral Disagree Disagree 

1 2 3 4 5 

15. This technical assistance was relevant to substance abuse 

treatment. 

1 2 3 4 5 

16. I would recommend this technical assistance to a colleague. 

Very Not 

Useful Useful Neutral Useless Applicable 

17. How useful was the information you received from the 

instructor? 1 2 3 4 5 

18. Please indicate which title best describes your job: 

___Medical Director ___Clinical Administrator/Manager ___State Government Official 

___Physician ___Clinical Supervisor ___County Government Official 

___Nurse ___Psychologist ___Researcher 

___Physician's Assistant ___Counselor ___Other (please specify)____________ 

___Pharmacist ___Social Worker 

___Manager Director ___Federal Government Official 

19. Please indicate which best describes your agency or affiliation: 

___Federal Government ___Substance Abuse Treatment Program 

___State Government ___University or other higher education institution 

___County Government ___Other (please describe)_________________________________ 

___Local Government 

20. What is your gender? 1.____Male 2.____Female 

21. Are you Hispanic or Latino? 1.____Yes 2.____No 

22. What is your race (Mark all that apply)? 

____Black or African American ____Alaska Native 

____Asian ____American Indian 

____White ____Native Hawaiian or Other Pacific Islander 

What about the technical assistance was most useful in supporting your work responsibilities? 

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How can CSAT improve its technical assistance? 

Thank you for completing our survey. 

Return your survey to the Survey Administrator for your Session. 

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