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<title>Evaluering for kursusledere</title>
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<tr>
<td align="center">
<table width="450" border="1" cellspacing="0" cellpadding="6" bordercolordark="#EEEEEE" bgcolor="#FFFFFF" bordercolorlight="#EEEEEE">
<tr bgcolor="#EEEEEE">
<td>
<div align="center"><b class="txthead">Kursusrapport for kursusledere</b></div>
</td>
</tr>
<tr>
<td class="txt"><b>Kursus<br>
<br>
</b>
<table width="450" border="0" cellpadding="2" cellspacing="0">
<tr>
<td width="118">Kursusnr.</td>
<td colspan="2"> <input type="text" name="kursusnr" size="10">
</td>
</tr>
<tr>
<td>Kursustitel </td>
<td colspan="2"><input type="text" name="kursustitel" size="32"></td>
</tr>
<tr>
<td>Kursusleder(e)</td>
<td width="60"><input type="text" name="navn" size="15"></td>
<td width="192"> </td>
</tr>
<tr>
<td>Underviser(e)</td>
<td><input type="text" name="underviser" size="15"></td>
<td> </td>
</tr>
<tr>
<td colspan="3">Kategori (vælg):</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox" value="1. Sundhedsfremme og forebyggelse">
1. Sundhedsfremme og forebyggelse</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox2" value="2. Sygdomsbehandling">
2. Sygdomsbehandling</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox3" value="3. Management">
3. Management</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox4" value="4. Kontakt og kommunikation">
4. Kontakt og kommunikation</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox5" value="5. Undervisning og forskning">
5. Undervisning og forskning</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox6" value="6. Andet">
6. Andet</td>
</tr>
<tr>
<td colspan="3">Målgruppe (vælg):</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox7" value="1. Læger ">
1. Læger </td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox8" value="2. Klinikpersonale">
2. Klinikpersonale</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox9" value="3. Læger og klinikpersonale ">
3. Læger og klinikpersonale </td>
</tr>
<tr>
<td colspan="3">Form (vælg):</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox10" value="1. Åbent kursus">
1. Åbent kursus </td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox11" value="2. Lukket kursus">
2. Lukket kursus</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox12" value="3. Lukket kursus inkl. workshop">
3. Lukket kursus inkl. workshop</td>
</tr>
<tr>
<td colspan="3"><input type="checkbox" name="checkbox13" value="4. Edb">
4. Edb</td>
</tr>
</table>
</td>
</tr>
<tr>
<td class="txt"> <b>Deltagere<br>
</b> <br>
<table width="450" border="0" cellpadding="2" cellspacing="0">
<tr>
<td width="107">Antal deltagere:</td>
<td width="335"> <input type="text" name="antaldelt" size="10"> </td>
</tr>
<tr>
<td colspan="2" class="txt"> Antal afleverede evalueringer fordelt
på:</td>
</tr>
<tr>
<td colspan="2"><table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td>P.L.O.
<input type="text" name="plo" size="10"> </td>
<td>FYAM
<input type="text" name="fyam" size="10"> </td>
<td>FAPS <input type="text" name="faps" size="10">
</td>
<td>Nordisk læge
<input type="text" name="nordisk" size="10"></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2"><table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td>Klinikpers. <input type="text" name="klinik" size="10">
</td>
<td>Pensionist <input type="text" name="pensionist" size="10">
</td>
<td>Andet <input type="text" name="andet" size="10">
</td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" class="txt"> Fordeling af score iht. afleverede
evalueringer fra deltagere: :</td>
</tr>
<tr>
<td colspan="2"> <table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="60"> </td>
<td> </td>
<td> <div align="center"><b>0</b></div></td>
<td> <div align="center"><b>1</b></div></td>
<td> <div align="center"><b>2</b></div></td>
<td> <div align="center"><b>3</b></div></td>
<td> <div align="center"><b>4</b></div></td>
<td> <div align="center"><b>5</b></div></td>
</tr>
<tr>
<td width="60"> </td>
<td><b>Spørgsmål 1.</b></td>
<td> <div align="center">
<input type="text" name="sp1_0" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp1_1" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp1_2" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp1_3" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp1_4" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp1_5" size="2">
</div></td>
</tr>
<tr>
<td width="60"> </td>
<td><b>Spørgsmål 2.</b></td>
<td> <div align="center">
<input type="text" name="sp2_0" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp2_1" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp2_2" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp2_3" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp2_4" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp2_5" size="2">
</div></td>
</tr>
<tr>
<td> </td>
<td><b>Spørgsmål 3.</b></td>
<td> <div align="center">
<input type="text" name="sp3_0" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp3_1" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp3_2" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp3_3" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp3_4" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp3_5" size="2">
</div></td>
</tr>
<tr>
<td> </td>
<td><b>Spørgsmål 4.</b></td>
<td> <div align="center">
<input type="text" name="sp4_0" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp4_1" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp4_2" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp4_3" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp4_4" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp4_5" size="2">
</div></td>
</tr>
<tr>
<td> </td>
<td><b>Spørgsmål 5.</b></td>
<td> <div align="center">
<input type="text" name="sp5_0" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp5_1" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp5_2" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp5_3" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp5_4" size="2">
</div></td>
<td> <div align="center">
<input type="text" name="sp5_5" size="2">
</div></td>
</tr>
</table></td>
</tr>
</table>
</td>
</tr>
<tr>
<td class="txt"><b>Udvælg relevante kommentarer fra den skriftlige
evaluering, som du finder interessant for Uddannelsessekretariatet
/ XXX administration</b><br>
<br>
<br>
<table width="450" border="0" cellspacing="0" cellpadding="2">
<tr>
<td width="60"> </td>
<td colspan="3">
<textarea name="kommentarer" cols="40" wrap="VIRTUAL" rows="8"></textarea>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td class="txt">
<p><b>Din evaluering:</b></p>
<p>Du gør vores planlægning lettere, hvis du begrunder
dine svar.</p>
<table width="450" border="0" cellpadding="2" cellspacing="0">
<tr>
<td colspan="4" class="txt">Finder du kurset egnet til gentagelse?</td>
</tr>
<tr>
<td width="60"> </td>
<td width="40"> <input type="radio" name="ja" value="ja">
Ja </td>
<td colspan="2" width="338"> <input type="radio" name="ja" value="nej">
Nej </td>
</tr>
<tr>
<td colspan="4" class="txt">Hvis ja:</td>
</tr>
<tr>
<td width="60"> </td>
<td width="40"> <input type="checkbox" name="ja_1" value="i samme form">
</td>
<td colspan="2" width="338">i samme form</td>
</tr>
<tr>
<td width="60"> </td>
<td width="40"> <input type="checkbox" name="ja_2" value="med samme underviser(e)">
</td>
<td colspan="2" width="338">med samme underviser(e)</td>
</tr>
<tr>
<td> </td>
<td> <input type="checkbox" name="ja_3" value="med dig som kursusleder">
</td>
<td colspan="2">med dig som kursusleder</td>
</tr>
<tr>
<td colspan="4">Hvis nej, hvorfor ikke:</td>
</tr>
<tr>
<td> </td>
<td colspan="3"> <textarea name="ikke_egnet" cols="40" wrap="VIRTUAL" rows="3"></textarea>
</td>
</tr>
<tr>
<td colspan="4"> <p> </p>
<p class="txt">Var lokaleforholdene i orden? </p></td>
</tr>
<tr>
<td width="60"> </td>
<td colspan="3"> <textarea name="lokaleforhold" cols="40" wrap="VIRTUAL" rows="3"></textarea>
</td>
</tr>
<tr>
<td colspan="4" class="txt"> <p> </p>
<p>Fungerede de hjælpemidler, du havde bestilt, tilfredsstillende?
</p></td>
</tr>
<tr>
<td width="60"> </td>
<td colspan="3"> <textarea name="hjaelpemidler" cols="40" wrap="VIRTUAL" rows="3"></textarea>
</td>
</tr>
<tr>
<td colspan="4" class="txt"> <p> </p>
<p>Har du i forberedelses- og afviklingsfasen fået den
hjælp fra Uddannelsessekretariatet, du havde brug
for og var "Vejledning for kursusledere LD 2002"
en hjælp for dig? </p></td>
</tr>
<tr>
<td width="60"> </td>
<td colspan="3"> <textarea name="uddsekretariat" cols="40" wrap="VIRTUAL" rows="3"></textarea>
</td>
</tr>
<tr>
<td colspan="4" class="txt"> <p> </p>
<p>Kunne du tænke dig at være kursusleder igen
med et nyt emne?</p></td>
</tr>
<tr>
<td> </td>
<td> <input type="radio" name="igen" value="ja">
Ja </td>
<td colspan="2"> <input type="radio" name="igen" value="nej">
Nej </td>
</tr>
<tr>
<td> </td>
<td colspan="3">I givet fald evt. hvilket?</td>
</tr>
<tr>
<td> </td>
<td colspan="3"><textarea name="hvilket" cols="40" wrap="VIRTUAL" rows="3"></textarea></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td colspan="2"> </td>
</tr>
<tr>
<td colspan="4" class="txt"> <p> </p>
<p>Har du gode idéer eller kommentarer i øvrigt
mht. til kommende XXX (emner, form, ramme etc.)?</p></td>
</tr>
<tr>
<td width="60"> </td>
<td colspan="3"> <textarea name="ideer" cols="40" wrap="VIRTUAL" rows="3"></textarea>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td>
<table width="100%" border="0" cellspacing="0" cellpadding="2">
<tr>
<td width="60"> </td>
<td colspan="3">
<input type="image" src=../pics/send_2.gif border="0" name="Submit3" value="Send" alt="Send evaluering" width="100" height="18">
<!--<input type="submit" name="submit3" value=" Send evaluering">-->
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</form>
</body>
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