Tools & Templates

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.

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.

Checklist to review the steps involved in program evaluation, created by the State Birth Defects Program.

Template to construct a program logic model, created by the State Birth Defects Program.

Evaluation plan template to draft your program evaluation plan, created by the State Birth Defects Program.

State birth defects program indicators for surveillance, capacity development, prevention, and referral.

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 to aid in program evaluation, which shows examples of partners and the roles they play.

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.

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.

Survey system monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults.

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.

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.

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.

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.

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.

Checklist is designed to remind field staff about equipment and safety precautions they need to take when embarking on a field investigation or any form of on-site follow-up.

Sample questionnaire for use by an acute pesticide-related illness and injury surveillance program. It includes questions that satisfy the data requirements for all of the core variables needed by CDC’s National Institute for Occupational Safety and Health. States will need to customize this questionnaire for their specific needs.

Two forms are examples of mechanisms that pesticide poisoning surveillance programs can use to track the case follow-up process to ensure that all needed information is collected and that appropriate referrals and agency contacts are made.

Sample data collection form for use by an acute pesticide-related illness and injury surveillance program. This data collection form is for states that choose not to use a standard questionnaire but collect data via an open-ended interview. States will need to customize this data collection form for their specific needs.

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.

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.

General guideline for collecting information by using a standardized assessment of housing units in the area and the population affected by a disaster.