Safety Ambassador

1. Safety Ambassador Feedback Form

This information will be used to help the National Safety Council improve the Safety Ambassador program. We appreciate your taking the time to complete this short survey. Thank you.

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* 1. What is your zip code?

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* 2. Did the information we provided meet your needs?

Yes

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* 3. Was the information easy for you to present?

Yes

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* 4. Who did you share this information with?

Local business

School

Family and friends

Church/Religious group

Local community event

Other (please specify)

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* 5. How many people did you reach?

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* 6. Was the information easy for them to understand?

Yes

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* 7. What type of response did you receive from those you presented to?

Very interested

Somewhat interested

Neutral

Somewhat uninterested

Very uninterested

Safety Ambassador

1. Safety Ambassador Feedback Form

Question Title

* 1. What is your zip code?

Question Title

* 2. Did the information we provided meet your needs?

Question Title

* 3. Was the information easy for you to present?

Question Title

* 4. Who did you share this information with?

Question Title

* 5. How many people did you reach?

Question Title

* 6. Was the information easy for them to understand?

Question Title

* 7. What type of response did you receive from those you presented to?

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* 8. How could we improve this outreach program?

Question Title

* 9. What is your email address?