COMMUNITY FEEDBACK QUESTIONNAIRE

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Feedback Questions

Please help us continue to improve our program by answering the questions below.

Have you heard, seen, or read anything in the past year about the opportunity for residents to securely store and safely dispose of unwanted or used sharps?

YesNoDon't Know

Have you used MED-Project sharps disposal services such as free mail-back packages to dispose of unwanted or used sharps this past year?

YesNoDon't Know

Please indicate how well you feel each following phrase describes the sharps disposal program that currently exist?

	Very well	Somewhat well	Not very well	Don't know/No opinion
Easy to Locate	Very well	Somewhat well	Not very well	Don't know/No opinion
Easy to Use	Very well	Somewhat well	Not very well	Don't know/No opinion
Easy to Access	Very well	Somewhat well	Not very well	Don't know/No opinion

Which statement do you agree with more (please select one):

I prefer have a free sharps mail-back package sent directly to my home address

I prefer to pck up a free sharps mail-back package at a mail-back distribution site

I prefer to be provided a free sharps mail-back package at the time that I purchase sharps

No preference

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COMMUNITY FEEDBACK QUESTIONNAIRE

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