Quarter 2 Health Fair Report - NJ Poison Control Center

Information for Health Fairs that have taken place April 1, 2020 – June 30, 2020

Facilitator's Name*
First Last
Facilitator's Agency*
Host Organization(s)*

Name of the organization that has organized the event
Event Name
Event Address*
City State ZIP Code
County*
Contact Person
First Last
Phone (Event Contact)
Email (Event Contact)
Event Date*
MM slash DD slash YYYY
Program Evaluation
Willingness of group to learn
Score from 1-4, 4 begin the highest.
Program Setting
Score from 1-4, 4 begin the highest.
Participation from group
Score from 1-4, 4 begin the highest.
Program coordinator
Score from 1-4, 4 begin the highest.
Did the audience save the Poison Help line as a contact in their cell phones?
Do you feel this program should be contacted for another program in the future?
- Yes
- No
If yes, when? If no, why?
Additional Comments
Materials Distributed at Site
Fill in a quantity for each field
Phone Stickers (English)*
Phone Stickers (Spanish)*
Babysitter (English)*
Babysitter (Spanish)*
Carbon Monoxide (English)*
Carbon Monoxide (Spanish)*
Your Poison Center (English)*
Your Poison Center (Spanish)*
Keep Your Family Safe/PIYH (English)*
Keep Your Family Safe/PIYH (Spanish)*
Magnets (English)*
Magnets (Spanish)*
Dila a una amiga
Medicine Spoons*
Poison Help Stickers (English)*
Poison Help Stickers (Spanish)*
Wallet Cards*
Poster - Pets Get Poisoned Too*
Poster - Mistaken Identity*
Poster - Medicine Safety*
Poster - Poison Center Services (English)*
Poster - Poison Center Services (Spanish)*
Pens*
Pencils*
Magnifier*
Pop Socket*

Program Evaluation