Yuk Box Evaluation Form

Name*

First Last Email

Organization*

Other Attendee*

Did anyone else attend?

Activity/Event Date*

Activity/Event*

Provide the name of the event, activity, conference, etc.

Activity Role*

Activity Type*

What type of event was this?

Please check all that apply

Meets grant requirement (Check if event was in one of the following cities: Auburn, Bellevue, Bothell, Burien, Covington, Des Moines, Federal Way, Issaquah, Kenmore, Kent, Kirkland, Mercer Island, Redmond, Renton, Sammamish, Seatac, Shoreline, Tukwila, or Seattle.) Select city below.
Health Care Facility Education
Public Health Education
School Assembly

Event City*

In what City was the event held?

County*

In what County was the event held?

State*

In what state was the event held?

Event Region*

What was the audience reach?

Audience Type*

Select the PRIMARY target audience for the event.

Number of Attendees*

Estimate how many people attended, saw the Washington Poison Center booth, interacted with staff, etc.

Useful event*

Was this event useful, or should we attend next year if offered?

Yes
No
Not sure

File Upload

Upload any materials pertinent to the event. Materials provided by us, event flyers, a screenshot of something you saw and felt was important, etc.

Max. file size: 600 MB.

Overall, how satisfied are you with the Yuk Box program?*

Very Satisfied
Somewhat Satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very satisfied

How helpful were the tools in the Yuk Box to raise awareness in your community on poison prevention, home safety, and Washington Poison Center services?*

Extremely helpful
Very helpful
Somewhat helpful
Not so helpful
Not at all helpful

Because of what your community learned about the Washington Poison Center, how comfortable does your community feel calling the 1 (800) 222-1222 number?*

Extremely comfortable
Very comfortable
Somewhat comfortable
Slightly comfortable
Not comfortable

How could this Yuk Box program be improved?

Do you have any feedback for the Yuk Box program?

From which location did you check out your Yuk Box?*

Yuk Box Evaluation Form

Public Health Education Activities