PPF Weekly Engagement Survey

Please complete this survey to report on your activities as a PPF Health Ambassador. Please be as thorough as possible, but report on any interactions anonymously. Thank you!

Email(Required)

Select the Sunday that starts the calendar week you are reporting on:(Required)

Name(Required)

Select the community you are a PPF Ambassador for:(Required)

OUTREACH SUMMARY

How many total people did you engage with this week?(Required)

Please enter a number greater than or equal to 0.

Of the people you engaged with this week, how many were 1:1 conversations?(Required)

Please enter a number greater than or equal to 0.

How many hours did you spend engaging with people on health materials this week?(Required)

Please enter a number greater than or equal to 0.

How many people did you connect to PPF screens this week?(Required)

Please enter a number greater than or equal to 0.

How many people did you direct to a health care resource?(Required)

Please enter a number greater than or equal to 0.

How many people reported a new follow up with a healthcare provider?(Required)

Please enter a number greater than or equal to 0.

How many people reported completing a new screening for a health condition?(Required)

Please enter a number greater than or equal to 0.

What were the top health conditions or concerns that people wanted to better understand? (select 1-3)(Required)

Any health conditions or concerns not listed above?

Provide an estimate of the number and description of materials you shared this week. (example: 15 ThriveGlobal cookbooks, 20 cancer screening flyers)(Required)

What are the top barriers to health that people are identifying this week? (select 1-3)(Required)

Any barriers to health not listed above?

ENGAGEMENT - HEALTH IMPACT STORIES

The purpose of an impact story is to highlight the important work that Ambassadors do to drive better health in their communities, and the outcome of that work (testimonials of people taking action or reporting positive changes).

Please take a moment to reflect on the conversations around health and wellness you had this week.

We want to hear about meaningful health-focused interactions you had, notable events or activities you participated in, and most importantly - the impact that these interactions had on yourself or others.

Please do not include identifying information in your stories.

STORY 1: Share one impactful story of a health conversation or moment you had this week.(Required)

STORY 2: Share one impactful story of a health conversation or moment you had this week.

Please leave any questions, feedback, or information you want to provide the PPF team:

CAMPAIGN REPORTING
Campaigns are health topics of focus for the CHA Program. Partner organizations provide custom health content and messaging to increase awareness and education. Campaigns may be promoted across the entire program (ex: ThriveGlobal Cookbook) or campaigns may be specific to a city (ex: AHA Women's Heart Health). Please use the Campaign Reporting section to report on your engagements on these specific health topics.

Did you participate in any campaigns this week?(Required)

Yes

CAMPAIGN 1: Which campaign topic are you reporting on?

How many people did you engage on this campaign topic? (during 1:1 conversations, group settings, events, and other activities)

Please enter a number greater than or equal to 0.

Of the people you engaged with on this topic, how many were 1:1 conversations?

Please enter a number greater than or equal to 0.

How many events did you attend or host related to this campaign topic?

Please enter a number greater than or equal to 0.

How many people did you reach at events related to this campaign topic?

Please enter a number greater than or equal to 0.

Please provide an estimate of the number and description of campaign-related resources you shared out.

How many people did you direct to a health care resource related to this campaign topic?

Please enter a number greater than or equal to 0.

How many people reported a new follow up with a healthcare provider related to this campaign topic?

Please enter a number greater than or equal to 0.

How many people reported completing a new screening for this health topic?

Please enter a number greater than or equal to 0.

Impact Story or Additional Details

CAMPAIGN 2: Which campaign topic are you reporting on?

How many people did you engage on this campaign topic? (during 1:1 conversations, group settings, events, and other activities)

Please enter a number greater than or equal to 0.

Of the people you engaged with on this topic, how many were 1:1 conversations?

Please enter a number greater than or equal to 0.

How many events did you attend or host related to this campaign topic?

Please enter a number greater than or equal to 0.

How many people did you reach at events related to this campaign topic?

Please enter a number greater than or equal to 0.

Please provide an estimate of the number and description of campaign-related resources you shared out.

How many people did you direct to a health care resource related to this campaign topic?

Please enter a number greater than or equal to 0.

How many people reported a new follow up with a healthcare provider related to this campaign topic?

Please enter a number greater than or equal to 0.

How many people reported completing a new screening for this health topic?

Please enter a number greater than or equal to 0.

Impact Story or Additional Details

Weekly Engagement Form, Revision 1

PPF Weekly Engagement Survey