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CONTACT INFORMATION
| Year |
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| State |
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| Date |
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| Name |
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| P.O. Box |
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| Address 1 |
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| Address 2 |
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| City |
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| State |
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| Zip |
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| Phone |
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| Fax |
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| Email |
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| Website |
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I. YOUR PROGRAM
| A. List the goals for the past year |
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| B. List the various partners who are involved in your state program |
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II. STATE OPERATION LIFESAVER TRAINING
| A. Presenter – Trainer Resources |
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| 1. Number of Presenters who gave FOUR OR MORE PRESENTATIONS during the past year?: |
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| 2. Number of certified ASSOCIATES who helped your state program during the past year?: |
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| 3. What kinds of activities did your Associates help with?: |
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B. Presenter Statistics |
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| 1. Number of NEW PRESENTERS certified this year: |
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| 2. Number of NEW ASSOCIATES certified this year: |
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| 3. Where did your find new Presenters and Associates? |
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C. Presenter Attrition Information |
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| 1. Total number of Presenters who left your OL program last year: |
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| 2. How many left for each of the following reasons: |
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| Job Change | |
| Retired | |
| Moved | |
| Lost Interest | |
| Decertified | |
| Deceased | |
| Unknown | |
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D. Presenter Recognition Activities |
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| Does your state program have a way of showing appreciation to its volunteers? (Check all that apply.) |
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| Incentive Awards Program | No |
| Appreciation Event | No |
| Other | No |
| If Other, explain | |
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E. Presenter Meetings |
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Do you hold state Presenter meetings for training updates, idea sharing, networking?
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III. PRESENTATION STATISTICS
A Presentation is defined by the 2002 Presenter’s Guide as follows:
- A formal presentation using the approved Operation Lifesaver, Inc. (OLI) format, given to given to two or more people.
- A presentation must be supported by the use of approved OLI visual aids, consisting of at least seven (7) visual charts, PowerPoint slides or overheads.
| A. Category |
Total No. of
Presentations |
Total No. of
Participants |
| K thru Grade 8 |
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General High School
(Includes School Assemblies and non-Drivers Ed Classes) |
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All Drivers Education
(Both High School Drivers Ed Classes and Adult Drivers Ed Classes) |
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| School Bus Drivers |
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| (NOTE: 4-Hour School Bus Trainer Courses should NOT be reported here. Report those ONLY in the Specialized Training section below, please, so we avoid double counting. |
| Other Professional Drivers: Truckers |
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| Other Professional Drivers: Commercial Buses |
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| Law Enforcement |
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| (NOTE: 4, 8 or 16 Hour GCCI Courses should NOT be reported here. Report those ONLY in the Specialized Training section below, please, so we avoid double counting. |
Emergency Responders: Fire Fighters
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| (NOTE: Emergency Responder Courses should NOT be reported here. Report those ONLY in the Specialized Training section below, please, so we avoid double counting. |
Misc. General Adult
(Civic Groups, Clubs, Mature Drivers, etc.) |
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Pre-K Headstart
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Snowmobile
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Totals
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IV. SPECIAL TRAINING STATISTICS
| Activity |
Total No. of
Clases |
Total No. of
Participants |
| School Bus Driver Trainers |
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| Driver Ed Trainer |
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| GCCI 4 Hour |
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| GCCI 8 Hour |
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| GCCI 16 Hour |
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| RSER |
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| Other |
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| Totals |
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| If Other, please specify: |
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V. SPECIAL EVENTS STATISTICS
| EVENT/ACTIVITY TYPE |
Total No. of
Events |
Total No. of
Participants |
| Mock/Staged Crash |
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| State/County Fair Exhibits/Booths |
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| Farm Show Exhibit |
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| Model Railroad Exhibit |
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| Other Conference Exhibits |
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| Community Safety Blitz |
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| Officer on the Train |
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| General OL Train |
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| Positive Enforcement Program |
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| School Bus Rodeos |
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| Trucking Rodeos |
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| Other |
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| Totals |
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| If Other, please specify: |
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VI. TRESPASS PREVENTION PROGRAMS
| A. Which do you consider your state's leading rail safety problem? (Check one): |
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| B. Where are your state's biggest railroad trespass problems located? |
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| C. What age/demographic group(s) do you focus on in your trespass prevention activities? |
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| D. Is your state involved in Community Partnerships? (Typically this involves the mayor's office/city government, plus police, schools, business, etc., in a neighborhood or community) When do you use Community Partnerships?: |
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| E. If you are involved in Community Partnerships, how many? |
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Please list the communities involved.
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VII. MEDIA
| Radio PSAs? |
No |
| Television PSAs? |
No |
| SMagazine / Newspaper PSAs? |
No |
| Billboard? |
No |
| B. Locally Produced PSAs: Did you use any of the following types of PSAs created locally last year? |
| Radio PSAs? |
No |
| Television PSAs? |
No |
| Magazine / Newspaper PSAs PSAs? |
No |
| Billboard? |
No |
| If you created PSAs locally, did you work with one of the following to create the PSAs? |
| Local Television Personality? |
No |
| Local Radio Personality? |
No |
| Sports Team Personality? |
No |
| Other (Explain) |
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C. Did you send any of the following to local newspapers last year?
(NOTE: If you have copies of any that were published, we welcome copies!) |
| News Releases? |
No |
| Letters to the Editor? |
No |
| Complaints About Bad Ads? |
No |
| D. Were any Media Awards given by your State Program last year? |
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If yes, please list to whom and what organization.
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| E. Does your state have it's own website? |
| No |
| If yes, what is your website's current address? |
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| 6. Does your state program publish a newsletter? |
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How Often?
If other, how often? |
| 7. Does your state program publish an e-newsletter? |
| No |
How Often?
If other, how often? |
VIII. FACTS ABOUT YOUR STATE PROGRAM
| 1. For emergency use only, in the space provided, may we please have your home address, telephone number, and cell phone number? |
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| 2. Do you have an assistant coordinator/co-coordinator or regional/area coordinator(s)? |
| No |
(If so, please provide their names and addresses here.)
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| 3. If the State Coordinator is not available to speak to the media, is there an approved ALTERNATE SPOKESERSON for your state program who may speak to the media? |
| No |
If yes, please provide the following:
Name of approved Alternate State Spokesperson:
Address:
Telephone Number(s):
E-mail:
OL Background/Other Background of Alternate Spokesperson (specify):
Under what circumstances should we contact your designated alternate state spokesperson (specify)?
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| 4. Is your State Program incorporated as an independent, non-profit, tax-exempt 501(c)(3) educational organization? |
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| If yes, when did you last check to see if your incorporation filing is up-to-date? |
| If yes, when did you last file a tax return for you state program? |
| If yes, when was your state program last audit or compilation? |
| If the answer to question 4 is "NO", does your State Program operate within another organization (e.g., as part of a state safety council, state department of transportation, etc.)? Please explain: |
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| 5. Does your state program have Bylaws? |
| No |
When were they last updated?
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| 6. How often does your State Board or Governing Body meet during the year? |
If other how often? |
| 7. Does your state program operate on a: |
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| 8. Please check the correct category to identify your general budget for the year: |
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| 9. Where does your financial budget come from? Please list your major sources and approximate percentage received from each: |
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| 10. List significant “In-Kind” services and estimated value in dollars that you received from your partners and contributors: |
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| 11. Board of directors/Executive Committee/Governing Body (You may enter their names, addresses and contact information here, or submit separately by e-mail or fax): |
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