30-day workplace transfer follow-up
Illustrative training-design sample. Not a record of delivered work. Self-reported behaviour only; not observed workplace practice.
Purpose
This form supports Kirkpatrick level 3 (behaviour): whether participants report applying kit skills at work about 30 days after the final session. Results are self-reported transfer, not observed behaviour.
Reference: Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick’s Four Levels of Training Evaluation. ATD Press.
When to send
- Timing: 30 calendar days after the final session (Session 3 or clinic, whichever ends the series).
- Reminders: For anonymous collection, send one general reminder to all invitees after seven days, asking those who already responded to disregard it. Use individual reminders only when participants consented to identifiable response tracking. Do not chase further.
- Anonymous option: Offer a link or paper form with no name field. If you track codes, use participant-held codes only; do not link to performance scores without consent.
Response scales
For items 1 to 10, use: 1 = 0 times; 2 = 1 time; 3 = 2–3 times; 4 = 4–6 times; 5 = 7 or more times; N/A = no relevant task or opportunity.
Choose N/A when no relevant opportunity occurred; choose 1 when an opportunity occurred but you did not apply the practice.
| # | In the last 30 days at work, I… | 1 | 2 | 3 | 4 | 5 | N/A |
|---|---|---|---|---|---|---|---|
| 1 | Used the AI use decision guide before a new AI use | ||||||
| 2 | Removed personal or identifying details before pasting text into any tool | ||||||
| 3 | Checked at least one consequential claim against its original source | ||||||
| 4 | Had a translation or public message checked by a fluent speaker before sending | ||||||
| 5 | Checked that my proposed AI use complied with my organization’s policy | ||||||
| 6 | Drafted or updated a transparency card for a proposed AI use | ||||||
| 7 | Told a colleague or manager about a safe practice from this training | ||||||
| 8 | Escalated an amber or red case instead of proceeding alone | ||||||
| 9 | Checked that the tool and data types were approved before proceeding | ||||||
| 10 | Recorded a green, amber, or red decision with an owner and review date |
If your organization had no AI policy, did you request guidance? Yes / No / N/A
Barriers and support
Barriers met (check all that apply):
Support wanted (optional, one line):
[response]
One example (optional)
Describe one task where you applied a kit practice. Do not include personal data, beneficiary names, case numbers, or operational locations.
[example]
Analysis and reporting
- Count responses and report the response rate (responses received divided by eligible participants).
- Report response distributions and valid n for each item. Report N/A and missing responses separately. Do not calculate item means or a combined transfer score; frequency is not proficiency.
- Always label results as self-reported transfer, not observed behaviour.
- Do not rank individuals or publish identifiable quotes.
- Feed a short summary into the sample final-report page (transfer section).
Level 4 (organizational results) is outside this kit’s scope; your organization may track outcomes separately with its own governance.