Advocate Survey  
Advocate’s Name_____________________ 
 
Questions related to the exam:  
1. Did the nurse have everything that was needed to perform the exam (cart stocked, supplies available)? ___Yes ___ No; explain _______________  

2. Did you have everything you needed to respond to the exam? ____ Yes ____ No: explain __________________  

3. How long was the victim at the hospital prior to your arrival? ___________  

4. How long did the entire process last? ____________  


 
What services did you provide to the victim:  
 
Information about WIN        Y  N  NA  
Supportive counseling        Y  N  NA  
Information about follow-up process       Y  N  NA  
Support for family and friends of victim      Y  N  NA 
Explain information concerning Victims Compensation Assistance  Y N NA 
Comments:  
 
Did the nurse who responded to the call:  
 
Respond to the call in a timely fashion (within an hour)   Y  N  NA 
Display respect for the victim       Y  N  NA  
Communicate clearly with the victim      Y  N  NA 
Display compassion for the victim       Y N  NA  
Display an understanding of the victim’s experience    Y  N  NA 
Provide information to the victim on health issues/follow-up   Y  N  NA  
Comments:  
 
Did the officer who responded to the call display:  
 
Display respect for the victim        Y  N  NA 
Communicate clearly with the victim      Y  N  NA 
Display an understanding of the victim’s experience    Y  N  NA 
Provide information on the investigative process/next steps    Y  N  NA 
Comments:  
 
 
What concerns (if any) presented during this exam (process)  
 
With victim  
 
 
With Law Enforcement  
 
 
With SART nurse 
 
 
With ER staff  
 
With family members/friends  
 
 
Is there anything else you would like to share about this exam/experience?  
 
 
Questions related to your experience as an advocate  
 
1. How long have you been an advocate?  


 
 
2. How many exams have you been involved in (approximately)?  


 
 
3. Rate your level of comfort with SART cases: 1-3 (scale)  


 1    2   3  
Somewhat Comfortable   Comfortable   Very Comfortable  
 
Questions related to your role on the SART team 
1. What is your greatest challenge in the SART advocate role?  


 
 
2. What is your greatest need as a SART team member?  


 
 
3. How would you describe the program/team as a whole:  


 
 
4. What changes to the process/ program would you suggest?  


 
 
Initials of Interviewer _______________  
 
 
 
Tools for Evaluating & Assessing Your SART/SANE Program (p. 16) by Pennsylvania Coalition Against Rape, n.d. Retrieved from www.pcar.org/sites/default/files/resource-pdfs/tools_for_evaluating_assessing_your_sart-sane_program.pdf Reprinted with permission.