Take Back Process Evaluation

The following survey requests feedback regarding the Prescription Drug Turn-In Event, held March 13, 2010. This survey is for event organizers only. The survey is anonymous.

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* 1. The information provided in the “Prescription Drug Turn-In Event: March 13, 2010 Guidelines For Holding An Event” was presented in a way that organizers understood clearly.

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* 2. Our site used the “Prescription Drug Turn-In Event” Flyer provided by Oregon Partnership and the Oregon Medical Association Alliance.

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* 3. The publicity provided for the Prescription Drug Turn-In Event was adequate.

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* 4. Our site distributed the Lock Your Meds “Home Medicine Inventory Card.”

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* 5. Please provide any additional comments you have about the materials you were provided for this campaign:

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* 6. 6. Please tell us about the actions you took leading up to the event:

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* 7. Please tell us what actions you took the actual day of the event:

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* 8. What factors do you believe were unique to your event location:

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* 9. What would you say worked, or did not work, about the Drug Turn-In Event:

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* 10. What changes in the community do you believe occurred through this collaboration:

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