St.

Paul University Philippines

Tuguegarao City, Cagayan 3500
SCHOOL OF HEALTH SCIENCES
TRAINING NEEDS ASSESSMENT TOOL
Thank you for taking the time to complete this questionnaire. The results of which
will be used to the custom design of the upcoming seminar that will be conducted
by the 5th year nursing students of St. Paul University Philippines. The data are
important to ensure that the seminar addresses your interests and needs. Rest
assured that the answers will be treated with confidentiality.
Name: (Optional) ___________________________________

Date: ___________________

Gender: ___________ Age: ______________ Years of service: _________________

Instruction: Please mark a check () for your chosen answer from the following
questions.
1. What are the health problems you want to be familiar with?
_______________________________________________________________
2. What are the current health problems commonly experienced by the
employees?
___Diabetes Mellitus
___Coronary Artery Disease
___Obesity
___Hypertension
___Heat exhaustion
___Stress
Others: ____________________
3. In line with question number 2, what are the health practices that usually do?
___Exercise
___Use over the counter drug
___Consult a doctor
___Seek herbolaryo/use herbal medicine
___search the internet for management
___ask friends/office workers
4. Are there any health-promotive and illness preventive activities done in the
institution?
Yes_____
No_____
If Yes, what are those activities?
___health education
___Morning/ Afternoon exercise (HATAW)
___BP monitoring
___Health Bulletin
___Others (please specify): ________________________
5. How often do you submit yourself for check-up?
___once a year
___every 6 months
___every 3 months

___every month
6. What are the reasons for seeking consultation?
___requirement for clearance
___any unusual signs and symptoms
___for health monitoring
Others: (Please specify)______________________________
7. Are you currently experiencing medical illness?
___Yes
___No
*For those who answered YES:
8. What do you think ar5e the factors that contribute to the occurrence of those
health-related problems?
___Family history
___Work
___Lifestyle
___Age
Others: (Specify)________________________________
9. How does illness affect your work?
___I get late
___I dont finish my job on time
___I have absences
Others: (Specify)_________________________________
10.What are the ways in preventing the frequent recurrence of the signs and
symptoms related to your illness?
___Exercise
___Diet
___Therapy
___Leisure activities (like watching movies, etc.)
Others: (Specify)_________________________________