ToFEI and Feedback Form

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Dear Participant,

You are requested to complete the form. Your cooperation is highly
appreciated.

Thank you for your time
Regards!

ADITYA PANDEY
Health Advocate
Nada India Foundation, New Delhi
+91-8400424508

Source of this for form - Annexure IV of Guidelines for Tobacco Free Education Institute

Name of the Educational Institution:- *

Name of Participant
*

Designation of Evaluator *

student / Teacher / non teaching staff

Date of Evaluation
*

YYYY

Department/ Faculty *

Course *

EMAIL *

10-digit mobile number

AGE *

Display of ‘Tobacco Free Area’ Signage inside the premise of Educational Institute at all prominent place(s).

*

not there

present everywhere

The name/designation/contact number are mentioned / updated in the signage. Tobacco Free Area’ Signage inside the premise of Educational Institute at all prominent place(s).
*

Display of “Tobacco Free Education Institution” signage at entrance/ boundary wall of Educational Institute
*

The name/designation/contact number are mentioned / updated in the signage
*

No evidence of use of tobacco products inside the premise i.e. cigarette/beedi butts or discarded gutka/tobacco pouches, spitting spots.
*

Poster or other awareness materials on harms of tobacco displayed in the premise
*

Organisation of at least one tobacco control activity during last 6 months.
*

Designation of Tobacco Monitors and their names, designations, and contact number are mentioned on the signages
*

Inclusion of “No Tobacco Use” norm in the EI’s code of conduct guidelines
*

Marking of 100 yards area from the outer limit of boundary wall / fence of the Educational Institute
*

No shops selling tobacco products within 100 yards of the Educational Institute
*

GOOD HEALTH AS NATIONAL PRIORITY

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Join our campaign  Youth4tobaccoFreeIndia

Nada Young India Network believes in “Good Health as National Priority'' to create a healthy and safe space for all fellow Indians and individuals around the globe.
The theme echoes the concerns f youth to be the change-makers and create smoke and drug-abuse-free India. Good Health as a National priority shares a concern for the well-being of the young and hence stands to support and build Tobacco Free India.

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