Updated 17-02-10

Health Promotion Request Form

Name: ______Position: ______

Phone: ______Email: ______

Organisation: ______


Date of request: ______

1.Health issue/ problem
2.Who is the target audience? / Age:
Gender:
Type of group (eg. farmers, mums, seniors, ethnicity):
3.Proposed strategies
(Contact Health Promotion Officer for information on existing programs) / Existing program:
New idea:
4.Have you tried something already? / Yes No
If ‘yes’ explain:
What barriers have you found when trying to address the issue?
5.Who else have you already involved?
(eg. School, Shire, Bowls club)
6.What assistance are you seeking?
(See Role of Health Promotion Officer over page for ideas)
7.Location
8.Proposed timeline

Health Promotion Request Form – Information & Contact Details

For assistance completing this form please contact the Health Promotion Officer in your district.

Role of Health Promotion Officer:

  • Help identify local priority health issues for the community, which reflect National and State priorities.
  • Develop, plan, implement and evaluate health promotion programs and strategies together with stakeholders and the community.
  • Support and empower both staff and community groups to develop, plan, implement, sustain and evaluate local health promotion programs.
  • Organise and support educational and advocacy strategies to promote healthy behaviour.
  • Support state-wide health promotion campaigns when appropriate - including information about accessing resource materials and grant applications.
  • Prepare draft media release and advertising and develop this skill in other staff.
  • Organise and/or attend relevant partnership meetings to network and ensure partnerships for health promotion initiatives (i.e. partnerships with health services, local government, and private and community organisations).
  • Provide relevant presentations, workshops, seminars and reports to raise the profile of health promotion when requested.
  • Facilitate health promotion education/training for health service staff.
  • Provide expert knowledge in health promotion acting as a consultant to health providers, making recommendations for future health promotion programs that are consistent with strategic direction.
  • Conducts literature reviews, needs assessments and undertakes research in health promotion related topics to identify gaps and needs in service provision.

Local contact details:

Avon and Central Wheatbelt Primary Health - Based in Northam and covering York, Beverley, Quairading, Cunderdin, Tammin, Meckering, Dowerin, Goomalling, Toodyay, Wundowie and Northam.

Postal Address: PO Box 312, NorthamWA 6401

Phone: 9690 1320Fax: 9690 1694

Eastern Wheatbelt Primary Health - Based in Merredin and covering, Bruce Rock, Kellerberrin, Narembeen, Southern Cross, Westonia, Nungarin, Trayning, Kununoppin, Wyalkatchem, Koorda, Beacon, Bencubbin, Mukinbudin, Moorine Rock, Muntadgin, Doodlakine and Merredin.

Postal Address: PO Box 327, MerredinWA 6415

Phone: 9041 0444Fax: 9041 0424

Southern Wheatbelt Primary Health - Based in Narrogin and covering West Arthur, Williams, Cuballing, LakeGrace, Wickepin, Kondinin, Corrigin, Wagin, Kulin, Dumbleyung, Pingelly and Narrogin.

Postal Address: PO Box 477, NarroginWA 6312

Phone: 9881 0385Fax: 9881 0457

Western Wheatbelt Primary Health - Based in Moora and covering Moora, Miling, Watheroo, Dandaragan, Jurien Bay, Cervantes, Badgingarra, Dalwallinu, Kalannie, Pithara, Wubin, Buntine, Gingin, Lancelin, Guilderton, Seabird, Ledge Point, Wongan Ballidu, Wongan Hills, Ballidu, Cadoux, Victoria Plains, Calingiri, Yerecoin, Bolgart, Mogumber, Gillingarra, Chittering, Bindoon, Muchea, Wannamal, Dowerin and Goomalling.

Postal Address: PO Box 154, MooraWA6510

Phone:9651 0270 Fax: 9651 0284

Wheatbelt Aboriginal Health Service - Based in Northam and covering the whole Wheatbelt.

Postal Address: PO Box 407, NorthamWA 6401

Phone: 9690 2888Fax: 9690 2850

Wheatbelt Public Health Unit - Based in Northam and covering the whole Wheatbelt.

Postal Address: PO Box 337, NorthamWA 6401

Phone: 9622 4320Fax: 9622 4342

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Population Health - Wheatbelt

Primary Health Services in the Avon and Central, Eastern, Southern and Western Wheatbelt

Wheatbelt Public Health Unit and Wheatbelt Aboriginal Health Service