Center for Advocacy & Outreach

Anna Blank Building

1200 Pleasant Street

Des Moines, IA 50309

515.241.6728

Safe Kids Iowa Delivering Fire Prevention Grant Evaluation

Please submit this evaluation within 30 days of completing your Delivering Fire Prevention event. If you have questions or concerns, please call or email Anne Garinger at 515.241.6703 or WinegaAM@ihs.org. Thank you! 

Evaluation

 

First Name Last Name Email Organization Street City State Zip Phone Date of EventName of participating fire departmentHow many homes did you visit?How many batteries did you distribute?Please comment on your event overall. * Event Location  Name of participating pizza establishment*Name of participating pizza establishment Please comment on the receptiveness of these two organizations to the program.* Please comment on the receptiveness of these two organizations to the program. How many smoke detectors did you install? How many CO detectors did you install?  Did you run out of materials during your program?Did you encounter any non-English speaking homes? If Yes, what was the primary language?Did you have any homes not interested in participating? If Yes, please explain.Did you have volunteers from organizations other than your organization? If yes, please list the volunteers' names and affiliated organizations.Did the media cover your event? If Yes, please comment.Do you have leftover materials? If Yes, are you planning another DFP event with those materials?If Yes, when are you planning the DFP event?Approximately how many people were affected by your program?Did you install the hearing impaired detector?Name of participating State Farm Insurance agents (if applicable)