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Home Safety Month 2010 Program Evaluation

 

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1. Please enter your contact information below:

Please enter your contact information below:   Name:
Title:
Company:
Address:
City:
State:
Zip:
Telephone:
Fax:
E-mail Address:

2. Have you participated in Home Safety Month before this year?

Have you participated in Home Safety Month before this year?   Yes No

3. Have you used any or all program materials yet?

Have you used any or all program materials yet?   Yes No

4. If you answered "Yes" to the previous question, when did you use the program?

If you answered "No", do you plan to use it?

If you answered "Yes" to the previous question, when did you use the program? If you answered "No", do you plan to use it?   Yes
No

5. Did you visit the Home Safety Council's Web site?

Did you visit the Home Safety Council's Web site?   Yes No

6. Please share your thoughts on HSC.org and how you shared this resource with others.

Please share your thoughts on HSC.org and how you shared this resource with others.

7. Did you visit the MySafeHome Tour during Home Safety Month?

Did you visit the MySafeHome Tour during Home Safety Month?   Yes No

8. Please share your thoughts on the MySafeHome Tour and how you shared this resource with others.

Please share your thoughts on the MySafeHome Tour and how you shared this resource with others.

9. How many participants benefited from or used the materials?

How many participants benefited from or used the materials?

10. Evaluate the overall educational value of the "Hands on Home Safety" program. Rate each of the components on the basis of usefulness.

	Poor	Below Average	Average	Above Average	Excellent	N/A
Brochures	*Evaluate the overall educational value of the "Hands on Home Safety" program. Rate each of the components on the basis of usefulness. Brochures Poor	Brochures Below Average	Brochures Average	Brochures Above Average	Brochures Excellent	Brochures N/A
Poster	Poster Poor	Poster Below Average	Poster Average	Poster Above Average	Poster Excellent	Poster N/A
Resource CD	Resource CD Poor	Resource CD Below Average	Resource CD Average	Resource CD Above Average	Resource CD Excellent	Resource CD N/A
Web Materials	Web Materials Poor	Web Materials Below Average	Web Materials Average	Web Materials Above Average	Web Materials Excellent	Web Materials N/A
MySafeHome Tour	MySafeHome Tour Poor	MySafeHome Tour Below Average	MySafeHome Tour Average	MySafeHome Tour Above Average	MySafeHome Tour Excellent	MySafeHome Tour N/A

11. Did you make copies and distribute the information in the kit?

Did you make copies and distribute the information in the kit?   Yes No

If yes, how many?

12. Did you use the home safety articles for your company newsletter or intranet?

Did you use the home safety articles for your company newsletter or intranet?   Yes No

13. Did you display the poster?

Did you display the poster?   Yes No

14. Did you find the Spanish language materials helpful to participants?

Did you find the Spanish language materials helpful to participants?   Yes No

15. Which of the following resources did you find most valuable?

Which of the following resources did you find most valuable?   Web Site Materials Home Safety Month Brochure Home Safety Month Poster Newsletter-Ready Safety Articles Scald Burn Prevention Brochure Fire Safety Checklist Spanish Materials MySafeHome Tour

16. Are there any other materials that would help you for Home Safety Month 2011?

Are there any other materials that would help you for Home Safety Month 2011?

17. As a result of using these materials, would you say that participants are more aware of home safety and the causes of unintentional injuries in the home?

As a result of using these materials, would you say that participants are more aware of home safety and the causes of unintentional injuries in the home?   Definitely More Somewhat More No Change

18. How do you prefer to receive information and updates from the Home Safety Council?

How do you prefer to receive information and updates from the Home Safety Council?   Mail E-mail Web site

19. How would you rate your overall level of satisfaction with the information provided by the Home Safety Council?

How would you rate your overall level of satisfaction with the information provided by the Home Safety Council?   Excellent Good Fair Poor

20. Please rate the frequency in which the Home Safety Council communicates with you via e-mail.

Please rate the frequency in which the Home Safety Council communicates with you via e-mail.   Too little Just right Too much

21. If you have received them, please rate your overall level of satisfaction with the following HSC e-mail communications.

	Poor	Below Average	Average	Above Average	Excellent	Don't Receive
New HSC Web site	*If you have received them, please rate your overall level of satisfaction with the following HSC e-mail communications. New HSC Web site Poor	New HSC Web site Below Average	New HSC Web site Average	New HSC Web site Above Average	New HSC Web site Excellent	New HSC Web site Don't Receive
Expert Network News	Expert Network News Poor	Expert Network News Below Average	Expert Network News Average	Expert Network News Above Average	Expert Network News Excellent	Expert Network News Don't Receive
HSM E-Newsletter	HSM E-Newsletter Poor	HSM E-Newsletter Below Average	HSM E-Newsletter Average	HSM E-Newsletter Above Average	HSM E-Newsletter Excellent	HSM E-Newsletter Don't Receive
5 Ways to Support HSM	5 Ways to Support HSM Poor	5 Ways to Support HSM Below Average	5 Ways to Support HSM Average	5 Ways to Support HSM Above Average	5 Ways to Support HSM Excellent	5 Ways to Support HSM Don't Receive
Order HSM Materials	Order HSM Materials Poor	Order HSM Materials Below Average	Order HSM Materials Average	Order HSM Materials Above Average	Order HSM Materials Excellent	Order HSM Materials Don't Receive
HSM Webinar	HSM Webinar Poor	HSM Webinar Below Average	HSM Webinar Average	HSM Webinar Above Average	HSM Webinar Excellent	HSM Webinar Don't Receive
Share Your Feedback	Share Your Feedback Poor	Share Your Feedback Below Average	Share Your Feedback Average	Share Your Feedback Above Average	Share Your Feedback Excellent	Share Your Feedback Don't Receive

22. How do Home Safety Council’s communications compare to communications you receive from other organizations?

How do Home Safety Council’s communications compare to communications you receive from other organizations?   More effective Equally effective Less effective

23. Please provide specific comments on how the program could be improved.

Please provide specific comments on how the program could be improved.