Safe Medication- Safe Disposal Program - Student

Student Evaluation - www.surveymonkey.com/r/SMSD-student

Thanks for taking our survey to help us improve our program.

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* 1. Please list today's DATE.

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* 2. What county is the group located in: (e.g., Onondaga, Erie, Cayuga...)?

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* 3. How would you rate the overall Safe Medication - Safe Disposal Program (all 3 videos)?

Excellent

Good

Fair

Poor

Not applicable - did not watch all 3 videos

If "Fair" or "Poor" please explain.

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* 4. Overall, how would your rate (ONLY) the Safe Disposal video?

Excellent

Good

Fair

Poor

If "Fair" or "Poor" please explain.

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* 5. After watching the video, check any or all responses that you learned safe disposal can prevent:

Damage to the environment

Someone taking a medication by accident

Someone taking a medication on purpose to abuse it

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* 6. According to the video, what is the BEST way to dispose of medication safely?

Mix and Toss

Take it Back

Flush

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* 7. If that first choice was not an option, what is the next best way to dispose of medications safely?

Mix and Toss

Take it Back

Flush

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* 8. In the video, what did "keeper of information" mean?

YOU are responsible for disposing of all the medicines in your home.

Your little brothers and sisters are responsible for disposing of all the medicines in your home.

While parents or other adults are responsible for disposing of medications from your home, you can share the information you learned about safe medication disposal with them.

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* 9. Did you program your cell phone with the Poison Helpline/poison center phone number?

Yes

No, but I will later

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* 10. Do you think you will share the information you learned today with your family?

Yes

Maybe

Thanks for participating and for taking our survey!