1. Approximately how many students in your class participated in the Safety Program?

2. Approximately how many classroom hours did students spend on the program?

None      1      2      3     4     5     6     More than 6

3. How did students use the safety materials? (Check all that apply)

Full-class activity  

Group/partial-class activity

Individual activity

Homework

We appreciate any additional comments

4. Having used the program, do you think your students will be safer around electricity and natural gas?

Yes      No

If yes, why?

5. Did students take the program materials home?

Yes      No

6. Did students who took the materials home share the safety messages with parents and/or siblings?    

Yes      No

7. Please rate the program materials on the following:

We appreciate any additional comments:

8. How important is it to you that the program materials support your state education standards?

Critically Important     

Very Important          

Somewhat Important   

Slightly Important         

Doesn’t Matter

9. Overall, how would you rate the Student Safety Program?

Excellent      Very Good      Good      Fair      Poor

We appreciate any additional comments:

10. How likely are you to participate in this program again next year?

Very Likely     

Somewhat Likely          

Not Sure   

Somewhat Unlikely         

Very Unlikely

11. What is your overall opinion of Duke Energy?

Excellent      Very Good      Good      Fair      Poor

12. How can Duke Energy improve this program?

13. Please provide the following information:

School Name

Grade Level

14. May we contact you to learn more about your opinions of these materials?
If so, please provide contact information:

Your Name

Your E-mail and/or Phone