Teacher/School Nurse Program Monitoring Survey

The Arizona Department of Health Services (ADHS) wants to evaluate your experience with teaching using the SunWise toolkit. Your responses will be 100% confidential. Taking a few minutes to answer the following questions will help us improve our ability to assist you with SunWise. In addition, your completed evaluation will enter you into a drawing for SunWise beads.


About You

Your Name



Your School


SunWise Toolkit

How did you receive the SunWise toolkit?

* Had you ever used the SunWise toolkit prior to May 2005 (when the state mandate occurred)?

* Do you prefer the electronic or paper SunWise toolkit?

* Please select all SunWise activities that you taught this school year.

Grades K-2

* Grades 3-5

* Grades 6-8

* How did you select the SunWise activity(s) you taught this year?

* If your teaching activities were selected for you, were they selected by (check all that apply):

* Overall, using the SunWise toolkit was:

* Do you have any suggestions for improving the SunWise toolkit?


Student Interest

Please rank students’ overall interest in SunWise activities compared to other school activities.

* Do you have any suggestions for increasing student interest in SunWise?


Student Knowledge/Behavior Change

Please complete this section only if you have taught one or more of the SunWise activities listed above. If you did not teach any of the activities, please skip down to the School Sun Shade Section.

Have you noticed a change in any of the following student behaviors after teaching SunWise activities?

Wearing sunscreen when outside?

* Wearing hats when outside

* Wearing long sleeves when outside

* Wearing sunglasses when outside

* Seeking shade between 10 a.m. and 4 p.m. when sun is most intense

* Ability to identify ultraviolet radiation as source of harmful effects of sun

* Ability to provide examples of health effects of sun exposure on eyes

* Ability to provide examples of health effects of sun exposure on skin


School Shade Covering

Does your school have any covering that protects playground(s) from the sun?


Additional Sun Safety Information

Have you contacted any sources other than the Arizona Department of Health Services for additional sun safety resources?

* Did you know that the Arizona Department of Health Services provides free school assemblies, faculty workshops and sun safety literature to teachers?

* Do you have any suggestions for the Arizona Department of Health to assist you in teaching sun safety?

* Please rate your interest in the following sun safety topics for your class:

  Very Interested Interested Somewhat Interested Not Interested
Sun safety beads and Frisbees
Information for parents
The dangers of tanning booths and sun lamps
Choosing the right sunscreen
Heat related illness
Vitamin D and the sun

* Additional Comments

* If you would like to receive information about upcoming free school assemblies, faculty workshops, sun safety literature and other exciting opportunities via email, please provide your email address below. Your email address will remain 100% confidential and will only be used for information regarding the SunWise school program.