Smokefree Activation Report - Tobacco Control NZ

First name(Required)

Last name(Required)

Email(Required)

Phone(Required)

Activation Name(Required)

Date/s of Activation(Required)

Location of Activation(Required)

Outline the activities provided at your activation including the smokefree activities.(Required)

What was the smokefree key messaging at your activation?(Required)

How was your key messaging delivered at your activation?(Required)

To your knowledge, has anyone started their quit journey as a result of your activation?(Required)

Did your activation provide a positive experience for your intended participants? How do you know? (Māori, Pasifika, Young People/Taiohi, Hapū Māmā, Disabilities, Mental Health)(Required)

Please share feedback or community insights received from your activation participants (quotes, recordings, messages etc)(Required)

Share your experience of working with your local stop smoking service and other stakeholders.(Required)

Was there anything that could have gone better at your activation?(Required)

What impact has this activation had on whānau/community?(Required)

How will you continue Smokefree health promotion and what support would you require to sustain this?(Required)

Please provide a breakdown of how the budget was spent on this activation: (i.e. kai, venue hire, koha)

Use as many item lines as needed.

Please remember to attach copies of your receipts on the next page.

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Cost(Required)

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Total costs

File upload

Please upload photos, videos and receipts related to your Smokefree Activation here

File(Required)

Drop files here or

Max. file size: 150 MB.

Report Form

Smokefree Community Activation Grant

SMOKEFREE ACTIVATION GRANT REPORT

File upload

Email

Phone