Tools & Templates

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Data Sharing Agreements
Evaluation Templates
Survey Questionnaires
Software
Surveillance Forms
Toolkits

Below are links to tools and templates developed by specific surveillance programs that may be adapted for use by other programs. They include data sharing agreements, evaluation templates, survey questionnaires, slide sets, software, forms, and toolkits.

Click on the plus ( + ) sign to expand the list of documents for the topic areas under the following tools and templates:

Data Sharing Agreements

Examples of program templates for data sharing agreements.

Pregnancy Risk Assessment Monitoring System (PRAMS) Researcher Data Sharing Agreement pdf icon
Researchers requesting access to multi-state PRAMS datasets must submit an application and this data sharing agreement. The data sharing agreement is signed by the principal investigator and co-investigators affirming that they and their designated staff will comply with the requirements in the agreement.

Evaluation Templates

Examples of evaluation guides, plans, worksheets, and checklists, and program logic models.

Developing and Using a Logic Model
Clarify approaches to and methods for evaluation, provide examples specific to the scope and purpose of the state chronic disease programs, and recommend resources for additional reading. Although examples provided in the guides are specific to HDSP programs, the information might also prove valuable to other state health department programs, especially chronic disease programs.

Evaluation Checklist for State Birth Defects Surveillance word icon
Checklist to review the steps involved in program evaluation, created by the State Birth Defects Program.
State Birth Defects Program Cooperative Agreements Conceptual Logic Modelword icon
Template to construct a program logic model, created by the State Birth Defects Program.
State Birth Defects Program Evaluation Plan Template word icon
Evaluation plan template to draft your program evaluation plan, created by the State Birth Defects Program.
State Birth Defects Program Indicatorsword icon
State birth defects program indicators for surveillance, capacity development, prevention, and referral.
State Program Evaluation Guides: Fundamentals of Evaluating Partnerships
Guide applies the CDC Evaluation Framework to evaluating your partnership. Lays out a six-step process for the decisions and activities involved in conducting an evaluation.
Worksheet for Capacity Developmentword icon
Worksheet to aid in program evaluation, which shows examples of partners and the roles they play.

Survey Questionnaires

Examples of CDC surveys and questionnaires.

National Health and Nutrition Examination Survey (NHANES)
A program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.

The Behavioral Risk Factor Surveillance System (BRFSS) (Scroll to Questionnaires)
World’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. Currently, data are collected monthly in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam.
The Youth Risk Behavior Surveillance System (YRBSS) Questionnaires
Survey system monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults.

State Program Evaluation Guides: Fundamentals of Evaluating Partnerships
Guide applies the CDC Evaluation Framework to evaluating your partnership. Lays out a six-step process for the decisions and activities involved in conducting an evaluation.

Software

Examples of CDC computer-based programs and applications for surveillance activities.

National Program of Cancer Registries (NPCR): EDITS—Tools for Writing Portable Edits
Collection of tools that allows standard-setters to create rules for data quality. Rules are created in an executable form using the EditWriter program, and are expressed in the EDITS language and embedded in a binary file object known as an NPCR–EDITS metafile.
Registry Plus^™—Software Programs for Cancer Registries
Suite of publicly available free software programs for collecting and processing cancer registry data. It can be used separately or together for routine or special data collection.

CDC EZ-Text
Software program developed to assist researchers create, manage, and analyze semi-structured qualitative databases.
Epi Info^™
Suite of lightweight software tools, delivers core ad-hoc epidemiologic functionality without the complexity or expense of large, enterprise applications. Includes easy form and database construction, data entry, and analysis with epidemiologic statistics, maps, and graphs.

SPIDER Database Software
Software that is capable of collecting, managing, and reporting in a standardized fashion all pertinent information needed by NIOSH and US EPA to conduct surveillance on acute pesticide-related illness.

Surveillance Forms

Examples of data collection forms and checklists.

CDC Shelter Assessment Tool
Assessment form assists environmental health practitioners in conducting a rapid assessment of shelter conditions during emergencies and disasters. It covers 14 general areas of environmental health, ranging from basic food safety and water quality to pet wellness, and allows for the documentation of immediate needs in shelters. Can be easily modified to meet local needs.
Public Health Assessment and Surveillance after a Disaster — Mortality and morbidity surveillance forms
Host of mortality and morbidity surveillance forms (e.g., Disaster-Related Mortality Surveillance Form, Disaster-Related Mortality Surveillance Instruction Form; Natural Disaster Morbidity Surveillance Individual Form Natural Disaster Morbidity Surveillance Line List Natural Disaster Morbidity Surveillance Tally Sheet Natural Disaster Morbidity Surveillance Summary Report Form). These forms are not meant to replace normal patient triage and record keeping or routine surveillance reporting mechanisms.

Pesticide-related Illness and Injury Surveillancepdf icon
A How-To Guide for State-Based Programs, including a Field Investigation Contact Form and Health Safety Checklist for Field Personnel, a Main Pesticide Exposure Questionnaire, a Pesticide Case Tracking Checklist and Contact Log, and a Pesticide Illness and Injury Surveillance Data Collection Form

Toolkits

Examples of CDC toolkits, which are a collection of information, resources, tools, and advice for a specific subject area or activity.

Community Health Assessment aNd Group Evaluation (CHANGE): Action Guide and Tool Downloads
Step-by-step instructions to follow for successfully completing the CHANGE tool. CHANGE can be used to gain a picture of the policy, systems, and environmental change strategies currently in place throughout the community; develop a community action plan for improving policies, systems, and the environment to support healthy lifestyles; and assist with prioritizing community needs and allocating available resources.
Public Health Surveillance Toolkit: A guide for busy task managers pdf icon[The World Bank]external icon
Fundamental concepts for surveillance in public health. Helps project teams and task managers critically assess the public health surveillance system (or systems) currently operating in a given country, and have some idea of ways to improve these systems.

Community Assessment for Public Health Emergency Response (CASPER) Toolkitpdf icon
General guideline for collecting information by using a standardized assessment of housing units in the area and the population affected by a disaster.

Injury Surveillance Training Manual (Instructor Guide and Participant Guide)pdf icon
Steps needed to establish and maintain an injury surveillance system; provides information on designing and monitoring prevention activities; and offers guidance for making informed decisions about injury prevention. Designed primarily for professionals who develop or operate surveillance systems and conduct prevention activities in less-resourced countries.

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Page last reviewed: November 27, 2019

Content source: Division of Health Informatics and Surveillance