Form 1 Alabama Outreach Activity Tracking form

OMB # 0925-0701
Expiration Date: 07/31/2017

Alabama Safe Sleep Outreach Project
Activity Tracking Form
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reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
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return the completed form to this address.

Organization:
Date of Report:

(Month/Day/Year)

Contact Person:
Telephone:
Email:
Address:

1.

What geographic area did the project activity serve? (include county and ZIP code for each area)

2.

Please describe all of the SIDS/safe infant sleep outreach activities that you conducted during this grant cycle (January 9,
2017, through July 31, 2017). Be as specific as possible. Please use additional pages if needed.

•

Total Number of Events:

•

Total Number of Participants Who Attended Events:

All Activity Tracking Forms must be turned in at the Closing Meeting on August 4, 2017.
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Alabama Safe Sleep Outreach Project

Activity
Example:
Safety Baby
Shower

Description

Event Date

Number of
Attendees

Desha County Health Unit
representatives partnered with
church officials from First Baptist
Church Day Care Center in McGehee
to train parents and child care
providers on safe infant sleep using
the Safe to Sleep® educational video
and print materials. The Bruce Family
Endowment provided a
supplementary in-kind donation for
this education initiative, which
covered meal expenses for training
participants.

1/9/2016

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Activity
Audience
—
—
—
—

Expecting mothers
New parents
Grandparents
Church members

Encounter:
Awareness
vs.
Educational
Educational

All Activity Tracking Forms must be turned in at the Closing Meeting on August 4, 2017.
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Alabama Safe Sleep Outreach Project
3.

Which safe infant sleep messages were the hardest for training participants to understand? Please explain.

4.

What parts of this project worked well and would you do again to make your outreach successful? Please explain.

5.

Do you feel you have the information and resources you need to raise awareness about ways to reduce the risk of SIDS and
to promote safe infant sleep in your community?

□
□

Yes
No

If no, what types of information or resources would be most helpful to you?

All Activity Tracking Forms must be turned in at the Closing Meeting on August 4, 2017.
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Alabama Safe Sleep Outreach Project
6.

With 1 being not at all helpful and 5 being very helpful, check a box to describe how helpful you felt the following materials
were in your outreach work.
a.

b.

c.

d.

Promotion materials (such as flyer template, sample social media posts, sample advertisement)
1
Not at all helpful

2

3

4

5
Very helpful

□

□

□

□

□

1
Not at all helpful

2

3

4

5
Very helpful

□

□

□

□

□

Educational presentations

Event planning materials (such as tips and tricks handout, planning checklist)
1
Not at all helpful

2

3

4

5
Very helpful

□

□

□

□

□

Educational materials (such as educational flipbook, safe sleep brochure, one-page handout)
1
Not at all helpful

2

3

4

5
Very helpful

□

□

□

□

□

All Activity Tracking Forms must be turned in at the Closing Meeting on August 4, 2017.
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