Evaluation of the TravAlert Electronic Messaging System

Data Collection for Evaluation of Education, Communication, and Training Activities

Attachment 4 - TravAlert Evaluation Tally Sheet

Evaluation of the TravAlert Electronic Messaging System

OMB: 0920-0932

Document [docx]
Download: docx | pdf

TravAlert Evaluation: Tally Sheet


PERSON APPROACHED              

DATE/TIME         

LOCATION APPROACHED             

ELIGIBLE      

IF INELIGIBLE, REASON

AGREED

1



Yes

No

Age

Language

International flight

Yes

No

2



Yes

No

Age

Language

International flight

Yes

No

3



Yes

No

Age

Language

International flight

Yes

No

4



Yes

No

Age

Language

International flight

Yes

No

5



Yes

No

Age

Language

International flight

Yes

No

6



Yes

No

Age

Language

International flight

Yes

No

7



Yes

No

Age

Language

International flight

Yes

No

8



Yes

No

Age

Language

International flight

Yes

No




NUMBER APPROACHED             

DATE/TIME         

LOCATION APPROACHED             

ELIGIBLE      

IF INELIGIBLE, REASON

AGREED

9



Yes

No

Age

Language

International flight

Yes

No

10



Yes

No

Age

Language

International flight

Yes

No

11



Yes

No

Age

Language

International flight

Yes

No

12



Yes

No

Age

Language

International flight

Yes

No

13



Yes

No

Age

Language

International flight

Yes

No

14



Yes

No

Age

Language

International flight

Yes

No

15



Yes

No

Age

Language

International flight

Yes

No

16



Yes

No

Age

Language

International flight

Yes

No

17



Yes

No

Age

Language

International flight

Yes

No



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCDC User
File Modified0000-00-00
File Created2021-01-31

© 2024 OMB.report | Privacy Policy