Southern Flu Coordinator Event Summary

Please complete this form and submit.

Event Date*
MM slash DD slash YYYY
Event Number (ex: 12345)*
Southern Operating Company*
- Alabama Power Company
- Georgia Power Company
- Mississippi Power Company
- Southern GAS Company
- Southern Power Company
- Southern Nuclear Company
Event Location*
Primary Contractor's Name*
Number of flu shots administered*
Please enter a number from 0 to 9999.
Did the event start on time?*
If no, please provide start time and explanation:
Did the event end on time?*
If no, please provide end time and explanation:
Please provide feedback regarding the overall event success (i.e. participant feedback, site contact feedback, etc.)*
Please list any issues that affected the outcome of the event (IE. missing supplies, staff issues, etc.)