Evaluating Unit Based Councils

Currently my hospital is strongly engaged in Shared Governance. We have had Unit Based Councils in place now on every floor for the last 4 years. Recently I have been challenged to come up with a way to evaluate the effectiveness of the invidivual unit UBCs. I have researched the internet looking for any type of evaluation form and have not come across anything. Does anyone have a form or suggestions of how to go about creating a form to be able to track this? Any input would be greatly appericiated. Thank you!!