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Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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C. TRANSLATION AND INTERPRETATION SERVICESWritten Translation Services1. Which <strong>of</strong> the following types <strong>of</strong> written materials are available to your clients in one or morelanguages other than English?One Twonon- non- Three or moreEnglish English non-EnglishMARK ALL THAT APPLY Language Languages Languagesa.In-take forms ............................ ~ ~ ~b. Materials regarding services available to clients ~ ~ ~c. Materials on how to access and appropriately use ~ ~ ~services ...............................d. Health education materials ................. ~ ~ ~e. Patient care instructions and forms ........... ~ ~ ~f. Medication instructions and forms ............ ~ ~ ~g. Grievance/complaint procedures and forms .... ~ ~ ~h. Client satisfaction questionnaires/surveys ...... ~ ~ ~i. Notification <strong>of</strong> language assistance ~ ~ ~~ Other, please specify _______________________________________~ None <strong>of</strong> the above2. Which <strong>of</strong> the following activities are used to develop written materials in languages other thanEnglish?MARK ALL THAT APPLY~ Verbatim translations from English into other languages~ Translations into other languages that are sensitive to specialized terms or concepts used in bothlanguages~ Translations into other languages that are prepared for the reading levels needed by persons withlimited English pr<strong>of</strong>iciency (LEP)~ Community input to ensure cultural sensitivity and appropriateness (e.g., pretest with focusgroups, community-based organizations, or members with LEP)~ Translated materials (from English into other languages) are back-translated into English~ Materials are originally developed in languages other than English~ Don’t know~ None <strong>of</strong> the aboveCOSMOS Corporation, December 2003 7

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