OMB CONTROL NUMBER: 0704-0627
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-0627, is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
60-Minute Training: WIT Implementer Fidelity Assessment
Your participation in this anonymous session feedback form is completely voluntary, your data will be held securely and only used for research purposes.
As a Violence Prevention Integrator (VPI) or third-party observer, please complete this form while the implementer is either delivering the WIT session or shortly after the completion of the WIT session.
Please identify the MAJCOM or component you are based out of.
Air Combat Command (ACC)
Air Education and Training Command (AETC)
Air Force District of Washington (AFDW)
Air Force Global Strike Command (AFGSC)
Air Force Materiel Command (AFMC)
Air Force Reserve Command (AFRC)
Air Force Special Operations Command (AFSOC)
Air Mobility Command (AMC)
Pacific Air Force Command (PACAF)
United States Air Forces in Europe-Air Forces Africa (USAFE-AFAFRICA)
United States Space Force (USSF)
Please indicate the installation you are based out of.
[Open-ended question] (Please do not include personally identifiable information (PII) in your response.) Needs hard check
Please indicate your level of agreement on how the implementer delivered the following components.
Introduction: |
Strongly Disagree |
(2) |
(3) |
(4) |
Strongly Agree |
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Introducing the Red Dots & Green Dots |
Strongly Disagree |
(2) |
(3) |
(4) |
Strongly Agree |
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Barriers to Reactive Green Dots & the Three Ds |
Strongly Disagree |
(2) |
(3) |
(4) |
Strongly Agree |
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Proactive Green Dots |
Strongly Disagree |
(2) |
(3) |
(4) |
Strongly Agree |
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“The Commitment” and Closing |
Strongly Disagree |
(2) |
(3) |
(4) |
Strongly Agree |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |