Injury Prevention Center - University Hospitals Rainbow Babies & Children's Hospital

Activity Report Greater Cleveland Safe Kids Coalition
Name of Agency*
Name of Event*
City*
Date (MM-DD-YYYY)*
Location*

Safety topics addressed (check all that apply):
Bike Safety	Firearm Safety	Seat Belts
Child Passenger Safety	Home Safety	Water Safety
Fall Prevention	Poison Prevention	Pedestrian Safety
Fire Prevention	Other:

Target Audience:
Preschool	Elementary School	Junior High
High School	Parents	Senior Citizens
College Aged	Other Audience

Type of Event:
(If Other, please specify):
Attendance (estimates are okay):*
How was this event marketed?	Fliers TV Radio Newspaper Other
Materials Used:
Evaluation
Comments
Report Completed By:*
Phone Number*
Total Hours Committed to Project*
Other Sponsors

*Asterik denotes required field

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