Student Evaluation Summary Report

STUDENT EVALUATION SUMMARY REPORT

DSHS 02-690 (REV. 08/2024)

Completed by the instructor based on all student class evaluations.

Use a separate sheet for each training.

This form required by

contract.

See Special Terms and

Conditions – Record

Maintenance.

TRAINING PROGRAM NAME

TRAINING PROGRAM NUMBER

PRIMARY CONTACT PERSON’S NAME AND PHONE NUMBER (INCLUDE AREA CODE)

COURSE

DATE

NUMBER OF STUDENTS

PHYSICAL ADDRESS OF CLASS

INSTRUCTOR NAME(S)

Summary of Evaluations

Indicate the average response to class evaluations with the statements below*:

1 = Strongly Agree 2 = Agree 3 = Neutral 4 = Disagree 5 = Strongly Disagree

* Round up .5 or above. See instructions for further explanation.

STATEMENT

1 2 3 4 5

The objectives of the training were clearly defined.

The content was organized and easy to follow.

The trainer was knowledgeable about the training topics.

The trainer was well prepared.

Participation and interaction were encouraged.

The training objectives were met.

The materials distributed were helpful.

The meeting room and facilities were adequate and comfortable.

INSTRUCTOR COMMENTS

STUDENT EVALUATION SUMMARY REPORT

DSHS 02-690 (REV. 08/2024)

Instructions

This form, or one that collects the same information, is required per your contract in the Special Terms and Conditions

section on Records Maintenance. It must be filled out by the instructor for each class and then maintained by your

business per contract Terms and Conditions.

Training Program Name:

The primary business name of your training program. Depending on your contract, it may be the “doing business as”

name.

Training Program Number:

Your training program number that appears on approval letters and certificates.

Primary Contact Person’s Name and Phone Number:

This is the person who is listed on your contract as the main contact person for your training program.

Course:

The name of the course as it appears on the certificate (i.e. Orientation and Safety, Core Basic, etc.)

Date:

The date student(s) filled out the class evaluation survey.

Number of Students:

The number of students who attended the class.

Physical Address of Class:

The location that the class was taught. Must provide the physical address (including city) on this form.

Instructor Name(s):

The person, or persons, who actually taught the class.

Summary of Evaluations:

This represents the average student response for each question.

• Round-up averages ending in .5 or above to the nearest response. For example, if responses to the first

question were 5, 4, 3, 2, 4, and 4, the average would be 3.6. You would check the box in the Number 4 column

as the average response.

• Round-down averages ending in .49 or below to the nearest response. For example, if responses to the first

question were 1, 2, 2, 5, 5, and 5, the average would be 3.3. You would check the box in the Number 3 column

as the average response.