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About Us
Preventing Child Injuries
Start a Shelter Program
Overview
Identify & Assess
Plan Your Visit
At the Shelter
Follow Up
Pre-Program Evaluation
Evaluation
August 26, 2021
Thank you for participating in the Boston Children’s Safe Shelter Program. Please fill out this survey so we can evaluate the success of the program. Your participation is greatly appreciated. Thank you for your help!
On a scale from 1 (very unsafe) to 5 (very safe), how safe is your facility?
Very Unsafe
Slightly Unsafe
So-so
Slight Safe
Very Safe
On a scale from 1 (very unfamiliar) to 5 (very familiar), how familiar are you with safety materials?
Very Unsafe
Slightly Unsafe
So-so
Slight Safe
Very Safe
How many safety materials are currently used in your facility (Must count one for each, different safety material)?
One
Two
Three
Four or more
None at all
Check or circle all of the items that you currently have in your facility.
Outlet covers
Door knob covers
Flat screen TV straps
Furniture wall strips
Window locks
Medication lock boxes
Radiator covers
Poison control magnets
Spout covers
Bath thermometers
Non slip bath appliques
Toilet locks
Oven locks
Stove knob covers
Spring latches (prevents cabinets and drawers from opening fully)
Refrigerator lock
Sliding cabinet locks
Baby gates
Blind cord shorteners
Other (Please Specify):
Enter other…
6. Do you believe that home safety materials can prevent a child or other children from getting hurt?
Yes
No
Maybe
Unsure
What are you hoping to learn from this program?
You have reached the end of the pre evaluation! We thank you for your time and hope that you and your family continue to stay safe.
Resources for Educational Activities
Powerpoint Talking Points
Tip Sheet
Safe Shelter Program Resources
Tip Sheet
Walk-through/Safety Needs Checklist
Tip Sheet
Educational powerpoint
Tip Sheet
More Resources