Form 1 Hospital Campaign Activity Scorecard

National Hospital Organ Donation Campaign's Activity Scorecard

ChallengeScorecard_Form_090513

Hospital Campaign Activity Scorecard

OMB: 0915-0373

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Plan Activities, Register Donors,
and Let Life Bloom
hospital campaign phase III challenge

Review the activities and corresponding points on the following pages. Plan your
hospital’s campaign activities, track them in this document, and watch your points grow.
Return this to your OPO or DLA affiliate. The points you accumulate will determine your
level of recognition in the WPFL Hospital Campaign.

500 Points =

250 Points =

100 Points =

Hospital 						
Hospital Contact:
Name 	

Email 	

Reporting OPO/DLA Affiliate		
OPO/DLA Affiliate Contact:
Name 	

POINTS TOTAL 			

Email 	

Hospital 		
# of each
Activity
Completed

Points
Per
Activity

Set a goal for the number of new registrations you want to reach through your campaign. Report your goal and progress to your
OPO/DLA affiliate.

75

# of each
Activity
Completed

New
Registratons

Goal Setting

Points
Per
Activity

New
Registratons

Hospital Communications and Events

65

Host a donor registry enrollment event in high-traffic hospital area.

50

Host a media event featuring a donor family/recipient reunion.

50

Hold a flag-raising ceremony for employees. Invite community members.

50

Hold a donor memorial service, candle lighting ceremony, or Tree of Life or other Thanksgiving celebration.

30

Host a campaign launch event and invite local media.

30

Add a campaign goal marker/barometer to your internal website.

30

Display a campaign goal marker/barometer in lobby and staff break areas.

30

Run hospital campaign public service announcements on your internal cable channel. Your OPO/DLA affiliate may
have PSAs you can use.

30

Implement the Give 5 – Save Lives tactic. (learn more here)

30 per program

Hold a program with guest donors, donor recipients, donor family members, and/or transplant professionals.

30 per presentation

Make presentations about organ donation and the campaign at departmental and physician meetings. Invite an OPO representative
to speak.

15

Display campaign posters and table tents in public and employee areas.

15 per email blast

Send email from hospital CEO or other leader(s) to staff, encouraging registration.

15 per email blast

Send emails from department heads to staff, encouraging registration.

15 per month

Place a campaign web banner and a link to the state registry on all internal email signatures and intranet sites for one month.

15 per month

Add pro-donation messages to employee pay stubs.

15 per article

Publish donation and transplantation articles in the hospital newsletter(s).

15 per video

Feature short videos about donation and transplantation on your internal cable channel. Access videos on www.organdonor.gov or
on YouTube by searching “organ donation.” Your OPO/DLA affiliate may also have videos you can use.

15

Include donation education materials and registry opportunities in every employee orientation packet.

15

Participate in National Blue and Green Day in April 2014.
continues next page …

Hospital 		
# of each
Activity
Completed

Points
Per
Activity

New
Registrations

Community Engagement and Events

65 per event

Provide donation information and the opportunity to register at all community health screening events.

65 per event

Partner with your local Chamber of Commerce to engage other businesses as workplace partners and co-host registry events.

65 per event

Partner with local EMS and other first responders in your community to promote donation and provide opportunities to register at
local community health events.

65

Implement a registry challenge competition among area medical schools or local universities and colleges.

65

Host an organ donation education program with your local television station.

65 per event

Link with your area blood center and co-host registry drives and events.

50

Donate billboard space for organ donation information.

50

Place an ad about organ donation in the local media.

50

Run public service announcements with local media. Your OPO/DLA affiliate may have PSAs you can use.

50

Create a pro-donation theme for use in community parades, events, and health fairs.

30

Send a letter or email from hospital CEO to other hospitals, vendors, or community organizations about the campaign.

30

Pitch donation or campaign-themed stories to local media.

30

Add a campaign goal marker/barometer to your external website with a link to your OPO/DLA or state registry.

30

Use social media sites (Facebook, Twitter, LinkedIn, Instagram) to highlight community donation events and encourage registration.

30

Seek the participation of the local Rotary Club in planning community health education programs.

30 for each partner

Invite vendors to join your campaign as workplace partners and ask them to provide educational information and registry
opportunities to their employees.

30

Submit letter to the editor urging donation registration to local newspapers and provide the state registry link.

30 per article

Publish donation and transplantation articles in a newsletter that goes out to the community.

15

Place posters in local businesses.

15

Enter a description of your own activity here:

POINTS TOTAL 			

Total New Registrations 		

Return your completed form to your OPO/DLA affiliate. If you have questions, contact your OPO/DLA affiliate or email [email protected].
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for
this project is 0915-XXXX. Public reporting burden for this collection of information is estimated to average XX hours per response, including the time for reviewing instructions, searching existing data sources, and completing
and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance
Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.


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