[Insert name of organization/activity and logo]       

[Insert Name of Material] Feedback Form

Your feedback is important and will help us improve our food safety education materials. Please take a few minutes to fill out this evaluation form.

1. Please share how useful the information provided in the [Insert Name of Material] is to you.
   Extremely Useful       Very Useful       Somewhat Useful      Not Very Useful       Not At All Useful
   
   
2. Do you intend to use the information you learned in the [Insert Name of Material] when handling foods?
   Yes               No            Maybe

3. What food safety topics do you want to learn more about and would you like to see included in our food safety materials?

4. How can the [Insert Name of Material] be improved?

5. If you plan to or have already shared and distributed the [Insert Name of Material] please write how many have or will be distributed. Also, describe how and to whom.

6. Would you like to receive email updates with of our latest food safety activities and information?
   Yes           No
   If yes, please provide your email address: _________________________________

7. Any additional comments?

Thank you!