Prevent Blindness Ohio: Survey - Play It Safe With Your Eyes Posttest

Play It Safe With Your Eyes Posttest

The Play it Safe with Your Eyes curriculum is funded by the Ohio Department of Health, Bureau of Child and Family Services, Save Our Sight Program (www.saveoursight.org). Please take a few minutes to provide the following information. All participants completing this form will receive a gift card.

Thanks for your help!

1.

Please provide the following information:

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Name:

First Required	Last Required

*

Email: Required

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Street 1: Required

Street 2:

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State/ZIP:

State Required	ZIP Required

Yes, I would like to receive e-mail from Prevent Blindness Ohio.

Yes, I would like to receive postal mail from Prevent Blindness America

Remember me. What's this?

*2.

Question - Required - School name:

(Maximum response 255 chars, approx. 5 rows of text)

*3.

Question - Required - How many students did you present the Play it Safe with Your Eyes curriculum to?

*4.

Question - Required - mark each of the following you presented/used with your students (mark all that apply):

	Lesson 1: The Importance of Sight
	Lesson 2: The Eye and How we See
	Lesson 3: Glasses, Why Some People Need Them
	Lesson 4: A World Without Sight
	Lesson 5: Taking Care of Our Eyes
	Hands on activities
	Video/DVD
	Recommended reading lists
	Puzzles
	Downloadable resources

*5.

Question - Required - How satisfied were you with the curriculum? Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Did not use curriculum

*6.

Question - Required - If you have used the curriculum in your classroom, which lessons, activities or resources were the most valuable/useful in your presentation to your students?

	Lesson 1: The Importance of Sight
	Lesson 2: The Eye and How we See
	Lesson 3: Glasses, Why Some People Need Them
	Lesson 4: A World Without Sight
	Lesson 5: Taking Care of Our Eyes
	Hands on activities
	Video/DVD
	Recommended reading lists
	Puzzles
	Downloadable resources

*7.

Question - Required - Which of the lessons, activities, or resources did your students like the most?

	Lesson 1: The Importance of Sight
	Lesson 2: The Eye and How we See
	Lesson 3: Glasses, Why Some People Need Them
	Lesson 4: A World Without Sight
	Lesson 5: Taking Care of Our Eyes
	Hands on activities
	Video/DVD
	Recommended reading lists
	Puzzles
	Downloadable resources

For each of the following, please mark whether you used the item and whether it added to the curriculum.

*8.

Question - Required - Did you use the Video/DVD?

*9.

Question - Required - Do you feel the item added to the curriculum?

*10.

Question - Required - Did you use the Activity Books?

*11.

Question - Required - Do you feel the item added to the curriculum?

*12.

Question - Required - Did you use the Puzzles?

*13.

Question - Required - Do you feel the item added to the curriculum?

14.

Question - Not Required - If you answered "no" to any of the questions above, please provide comments.

*15.

Question - Required - How did you use the Play it Safe with Your Eyes curriculum? In its entirety
Selected portions
Not at all
Don't know/Undecided

*16.

Which proficiency standards were met by this curriculum?

(Select one of the available choices or enter a different value.)
Question - Required -

17.

Question - Not Required - Please tell us about any lessons, activities, or resources used in your presentation that positively influenced eye health and/or eye safety behavior among your students.

*18.

Question - Required - Eye health and safety practices I observed among my students after the Play it Safe with Your Eyes curriculum were:

	Able to associate eyes with the ability to see
	Able to relate how vision can be improved or corrected by wearing glasses
	Able to tell another child/adult why good vision is important
	Able to tell another child/adult what blindness or vision impairment means
	Able to recognize the terms used for parts of the eye
	Able to name ways people with vision loss can take care of themselves
	Able to name or point to parts of the eye
	Able to name or point to at least four hazards to our eyes
	Able to describe how the eye works
	Able to tell another child/adult at least three safety rules for protecting eye from injury
	Discover how vision impairment feels and looks
	Able to explain what the eye doctor does to help us