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Evaluation Survey for Event Coordinators
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.
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.
Yes
No
Other
Other (please specify)
3.
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.”
Yes
No
If No, (please provide reason)
5.
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:
7.
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:
9.
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: