Evaluation Form

This evaluation form is required to be submitted after each activity. 

* Fields marked with an asterisk are required.

Date of Activity *

Day Month Year

Name of Activity *

Location *

Shepparton Kialla Mooroopna Tatura Murchison Dookie Bunbartha Congupna Katandra Merrigum Tallygaroopna Toolamba Undera Online Other

Location (other)

Age Demographic *

Tick all that apply Toddler / Preschool Primary School Secondary School 18 - 25 Years 25 - 35 Years 35+ Years 50+ Years

Number of Attendees *

Type of Activity *

Tick all that apply Sports & Physical Wellbeing Mental Health & Wellbeing Family Fun

Confirm which have been completed on facilitator checklist *

Tick all that apply Review pre-event risk assessment On site risk assessment Equipment set up OH&S for participants Pack up equipment Site clean up Incident reporting

Could a charge be applied at this event? *

Yes No

Could this activity be partnered with a community organisation? *

Yes No

Subject

Submit