Data Collection Plan Worksheet – <Project name> Data Type   Source, n numerator/denominator if % When collected By whom Diagnostic Data Outcome Measure(s) Baseline Results Process Counterbalance Measures(s)

Data Collection Plan - example Data Collection Plan Worksheet – Time from Surgery to Chemotherapy Data Type   Source, n numerator/denominator if % When collected By whom Diagnostic Data Checksheets for Reasons Patient Surveys (20) 1-15 May 2016 Office clerk(init) Outcome Measure(s) Baseline Patient charts All new Breast Cancer Patients 1 May-30 June 2016 Nurse (init) Results 1 July-31 Aug 2016 Nurse(init) Process   Patient chart Time from surgery to date referral received.  1 May – 30 June 2016 Counterbalance Measures(s) Patient Experience 1 Jun – 30 Jun 2016 1 Aug – 31 Aug 2016