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Safe-Communities-America-Program-Support-Tool

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					Safe Communities America Program Support Tools
This workbook consists of three excel spreadsheets: Injury Data Worksheet (Green Tab), Community Safety Inventory Worksheet (Yellow Tab) and Evaluation Worksheet (Pink Tab). These worksheets can assist communities in collecting information about their community's injury data, safety promotion and injury prevention programs, and program evaluation results. Instructions: Injury Data Worksheet (Green Tab) In the Community Profile column (B), enter the population data for your community. For example: Column B, line 4, enter the total population for your community. This information can be obtained from www.census.gov. Continue entering this data in column B for each category listed. I.e. gender, age, etc. For your community, enter the number of injuries and deaths for each cause of injury. For Example to enter Falls data: If there were 25 injuries from falls and two deaths, you would enter 25 in Column C, Line 4 and 2 in Column E, Line 4. Continue entering the number of injuries and deaths for each injury type and each demographic catagory listed for your community. Your community's injury and death rate per 100,000 people will appear in the columns following the number of injuries and deaths for each injury type. Upon entering the community profile and injury data, a formula will calculate these rates based upon the data entered in the Community Demographic column and in the injuries and deaths column for each injury type/cause. A dash will appear if no number or a zero is entered in any of the columns. Instructions: Community Safety Inventory (Yellow Tab) Program Name: Type the name of the safety promotion or injury prevention program in Column A.

Provided By: Type the name of the community group or organization that provides this program in your community in Column B. Target Population: Type an "X" in the column for each age group or target population for this program. Type of Environment: Type an "X" in the column for each type of environment for this program. Intentional Injury Prevention: Type an "X" in the violence or suicide column if this program addresses this type of intentional injury. Vulnerable Population: Type an "X" in the column a vulnerable or high risk group is the target population for this program Instructions: Evaluation Worksheet (Pink Tab) Program Name: Type the name of the safety promotion or injury prevention program in Column A. You can also copy this information from Column A in the Community Safety Inventory worksheet. Target Injury Issue: Type the injury issue that this program is designed to prevent. Target Population: Type the target population for this program. Reach of Program: Type the number of people reached or who received this program. Program Results: Type in the results or what changed as a result of this program.

Motor Vehicle Falls
Target Population Total Population Community Demographics Injuries Rate Deaths Rate Injuries

Poisoning
Rate Deaths Rate Injuries

Traffic
Rate Deaths Rate Injuries Rate -

Non-Traffic Deaths Rate -

Gender Males Females -

Age Children - Ages 0 -14 Youth - Ages 15 - 24 Adults - Ages 25 - 64 Older Adults - Over Age 65 -

Special Needs Persons with Disabilities -

Race/Ethnicity Asian Black Native American/Alaska Native Native Hawaiian/Pacific Islander White -

Persons of Hispanic/Latino

-

-

-

-

-

-

-

-

Developed by Safe Communities America National Safety Council

2

Fire, Flames, Smoke Target Population Total Population Injuries Rate Deaths Rate Injuries

Overexertion Rate Deaths Rate Injuries

Cut or Pierced Rate Deaths Rate Injuries Rate -

Choking Deaths Rate -

Gender Males Females -

Age Children - Ages 0 -14 Youth - Ages 15 - 24 Adults - Ages 25 - 64 Older Adults - Over Age 65 -

Special Needs Persons with Disabilities -

Race/Ethnicity Asian Black Native American/Alaska Native Native Hawaiian/Pacific Islander White -

Persons of Hispanic/Latino

-

-

-

-

-

-

-

-

Developed by Safe Communities America National Safety Council

3

Struck By/Against Object Target Population Total Population Injuries Rate Deaths Rate Injuries Rate -

Suicide Deaths Rate Injuries Rate -

Violence Deaths Rate -

Gender Males Females -

Age Children - Ages 0 -14 Youth - Ages 15 - 24 Adults - Ages 25 - 64 Older Adults - Over Age 65 -

Special Needs Persons with Disabilities -

Race/Ethnicity Asian Black Native American/Alaska Native Native Hawaiian/Pacific Islander White -

Persons of Hispanic/Latino

-

-

-

-

-

-

Developed by Safe Communities America National Safety Council

4

Injury Prevention/Safety Promotion

Provided By Children

Target Population Youth Ages 15-24 Adults Ages 25 -64 Older Adults Age 65 & Up

Program Name

(Name of Community Partner)

Ages 0 -14

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By

Type of Environment

Program Name

(Name of Community Partner)

Home

Traffic

Occupational

School

Sports

Leisure

Disaster

Other

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By

Intentional Injury Prevention

Vulnerable Groups

Program Name

(Name of Community Partner)

Violence

Suicide

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By Children

Target Population Youth Ages 15-24 Adults Ages 25 -64 Older Adults Age 65 & Up

Program Name

(Name of Community Partner)

Ages 0 -14

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By

Type of Environment

Program Name

(Name of Community Partner)

Home

Traffic

Occupational

School

Sports

Leisure

Disaster

Other

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By

Intentional Injury Prevention

Vulnerable Groups

Program Name

(Name of Community Partner)

Violence

Suicide

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By Children

Target Population Youth Ages 15-24 Adults Ages 25 -64 Older Adults Age 65 & Up

Program Name

(Name of Community Partner)

Ages 0 -14

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By

Type of Environment

Program Name

(Name of Community Partner)

Home

Traffic

Occupational

School

Sports

Leisure

Disaster

Other

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion

Provided By

Intentional Injury Prevention

Vulnerable Groups

Program Name

(Name of Community Partner)

Violence

Suicide

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion Program Name

Target Injury Issue What program addresses?

Target Population Who program is for?

Reach of Program How many were reached?

Results What changed due to the program?

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion Program Name

Target Injury Issue What program addresses?

Target Population Who program is for?

Reach of Program How many were reached?

Results What changed due to the program?

Developed by Safe Communities America National Safety Council

Injury Prevention/Safety Promotion Program Name

Target Injury Issue What program addresses?

Target Population Who program is for?

Reach of Program How many were reached?

Results What changed due to the program?

Developed by Safe Communities America National Safety Council


				
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posted:11/28/2009
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Description: Safe-Communities-America-Program-Support-Tool