Form #2 Form #2 Pre-Work for Master-Training

Attachment C

Pre-Work for Master-Training

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Date

Recipient’s name

Recipient’s address

RE: TeamSTEPPS Master-Training

Dear TeamSTEPPS trainers,

We look forward to seeing you soon for the TeamSTEPPS training to improve the safety of patients with limited English Proficiency (LEP).

A while back, you completed a readiness assessment survey to check whether your institution was ready for this training. Now, we ask that you complete a brief site assessment to help us have a productive training.

55 Wheeler Street  Cambridge, Massachusetts USA  02138-1168  617 492-7100 telephone  617 492-5219 facsimile

The site assessment includes completing a site assessment questionnaire, completing a language process map, and making a copy of your hospital’s or organization’s policy on accessing language services to bring to the training. We estimate these tasks may take approximately 30 minutes.

Please do not hesitate to let us know if you have any questions.

Best regards,

[Master-Trainer names, signature and contact information]

Public reporting burden for this collection of information is estimated to average 30 minutes per response, the estimated time required to complete the survey. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.