Play It Safe: Teacher/Coordinator Information and Evaluation Form

Dear Teacher,

We are pleased to help bring to your class "PLAY IT SAFE", a safety awareness program designed to educate young people about safety precautions in a rural environment.

This program was developed through the combined efforts of the University of Vermont Extension System, (name of your hospital) and other hospitals in Vermont, including Medical Center Hospital of Vermont, Copley Hospital, Fanny Allen Hospital, Central Vermont Hospital, Porter Medical Center and Northwestern Medical Center.

The presentation will last for one class period (approximately 40 minutes). It will include a slide show encompassing farm, machinery and other rural safety hazards with which rural children come in contact on a regular basis. A UVM Extension Safety Specialist, a health care professional and, in many cases, a victim of a farm accident, will share information about accident prevention. There will be adequate time for questions.

We will also be sending home a packet of information with each student, to include: a letter to parents explaining the program; a safety questionnaire/homework assignment for the children to fill out with their parents; a card for families to fill in directions to their home and phone numbers for emergency use; and a first aid information card. Samples of these items are attached for your reference.

The purpose of "PLAY IT SAFE" is to increase children's awareness about potential safety hazards in a rural setting, and help them learn how to keep themselves and their families as safe as possible. We encourage you to pique your students' interest with any introductory discussions which you feel are appropriate, and to follow up by reviewing the safety questionnaire with them and through any additional lessons and activities that fit into your curriculum.

The National Safety Council reports that each year 300 children die and 23,000 children suffer non-fatal injuries. One of the best tools we have to help prepare our children for life, work, play, and responsibilities is to teach them as much as we can about safety.

Thank you in advance for helping to ensure the safety of your students by complementing the efforts of "PLAY IT SAFE".

Please complete and return this evaluation form within the next 2 weeks. Thank you in advance for your cooperation.

1. Evaluate the 3 parts of the Play It Safe Program:

	Poor	Fair	Good	Very Good	Excellent
a) Slide Show	1	2	3	4	5
b) Health Professional	1	2	3	4	5
c) Accident victim	1	2	3	4	5

Comments:

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2. Evaluate the appropriateness of the resource materials provided.
PoorFairGoodVery GoodExcellent

Comments:

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3. What did you like best or did you find most useful to your students?

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4. How can the Play It Safe Program be improved?

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Thank you for your assistance.

Name: ___________________________________________

School: _________________________________________