Health Educator Tracker Health Educator Tracker Name(Required) First Last Email(Required) OrganizationDate MM slash DD slash YYYY Type of Active EngagementMeeting/ PresentationResidential OutreachVenue Visits/ EventsStreet OutreachOtherPlease describeType of Passive EngagementEmail (mass)Text/ telephoneResidential door dropsType of Social Media EngagementInstagramTwitterFacebookTiktokOtherNumber of Social Media LikesNumber of Social Media PostsPlease describeNumber of People Reached/ ImpressionsAddress City ZIP / Postal Code Other Identity Groups (select all that apply) Immigrants, including indigenous and undocumented individuals LGBTQ+ Persons over the age of 50 and/or with underlying health conditions Youth and young adults Pregnant and parenting people People who are disabled Persons experiencing homelessness Justice impacted people Domestic violence victims and survivors Gang involved individuals Unknown Language Used (select all that apply) English Arabic Armenian Chinese- Cantonese Chinese- Mandarin Farsi Japanese Khemer/Cambodian Korean Russian Sign Language Spanish Tagalog Thai Vietnamese Other Please describeSocial Media TrackingPlease provide a screenshot of your impressions Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 2 MB. Additional NotesPlease note anything that you would like to highlight about your engagement such as: Concerns about safety (e.g., both short and long term effects, etc.), Concerns about effectiveness (e.g. breakthrough infections, etc.), Recently diagnosed with COVID, Myths/misinformation, Lack of trust (e.g., changing information, messenger, etc.), Legal Issues
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