Evaluation Survey for Event Coordinators
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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.
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.
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.
Strongly Disagree
Disagree
Agree
Strongly Agree
2
. Our site used the “Prescription Drug Turn-In Event” Flyer provided by Oregon Partnership and the Oregon Medical Association Alliance.
Our site used the “Prescription Drug Turn-In Event” Flyer provided by Oregon Partnership and the Oregon Medical Association Alliance.
Yes
No
Other
Other (please specify)
3
. The publicity provided for the Prescription Drug Turn-In Event was adequate.
The publicity provided for the Prescription Drug Turn-In Event was adequate.
Strongly Disagree
Disagree
Agree
Strongly Agree
4
. Our site distributed the Lock Your Meds “Home Medicine Inventory Card.”
Our site distributed the Lock Your Meds “Home Medicine Inventory Card.”
Yes
No
If No, (please provide reason)
5
. Please provide any additional comments you have about the materials you were provided for this campaign:
Please provide any additional comments you have about the materials you were provided for this campaign:
6
. 6. Please tell us about the actions you took leading up to the event:
6. Please tell us about the actions you took leading up to the event:
7
. Please tell us what actions you took the actual day of the event:
Please tell us what actions you took the actual day of the event:
8
. What factors do you believe were unique to your event location:
What factors do you believe were unique to your event location:
9
. What would you say worked, or did not work, about the Drug Turn-In Event:
What would you say worked, or did not work, about the Drug Turn-In Event:
10
. What changes in the community do you believe occurred through this collaboration:
What changes in the community do you believe occurred through this collaboration:
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