Australian Trachoma Surveillance Report 2013

Data collection form—Health Promotion

Page last updated: 2015

Summary form 4—Health Promotion

This form was forwarded from the jurisdictional co-ordinators to the National Trachoma Surveillance & Reporting Unit (NTSRU) for checking and analysis. It recorded Health promotions by regions, communities and schools.

The Health Promotion summary form allowed for data to be collected for each program using 4 main criteria's:

These criteria's are grouped into the following options:


  • One-on-one
  • Presentation to group
  • Interactive group session
  • Social marketing/internet
  • Print Material
  • Mass media
  • Sporting/community events
  • Other

Target Audience

  • Health professional staff
  • Children/school students
  • Youth
  • Teachers/childcare or preschool staff
  • Care givers - e.g. Mothers
  • Community members
  • Community educators or health promoters
  • Interagency members


  • Occasional (2-4 times/year)
  • Regular (5-12 times/year)
  • Ongoing/routine (daily/weekly)
  • please specify duration

Note the below image is a sample only. For further information, refer to the PDF document Australian Trachoma Surveillance Report 2013

alternative text for the Trachoma Screening Form 4, Health Promotions is available on the page. (This form was developed by the National Trachoma Surveillance & Reporting Unit and used for data collection by jurisdictions) Summary Form 4 – Health promotion.Top of page