Form SOR_TOR Program Le SOR_TOR Program Le SOR_TOR Program Level Tool

State Opioid Response (SOR)/Tribal Opioid Response (TOR) – Program Instrument

For all program-specific questions below, consider the past three months as the reporting time period. Information and data should be reported for all programs/services either funded wholly or in part by SOR/TOR grant funds.

Information is reported quarterly as follows:

Q1: October 1–December 31; reporting due January 31

Q2: January 1–March 31; reporting due April 30

Q3: April 1–June 30; reporting due July 31

Q4: July 1–September 30; reporting due October 31

1	How many naloxone overdose kits (Narcan, Evzio, and others) has your state/territory/tribal entity purchased since the last reporting period? ____ kits If information is unavailable, please indicate why ________________
2	How many naloxone overdose kits (Narcan, Evzio, and others) has your state/territory/tribal entity distributed since the last reporting period? ____ kits If information is unavailable, please indicate why _______________
3	Of the naloxone overdose kits distributed since the last reporting period, how many overdose reversals occurred in your state/territory/tribal entity? ____ overdoses reversed If information is unavailable, please indicate why ___________________
4	How many fentanyl test strips has your state/territory/tribal entity purchased since the last reporting period? ____ fentanyl test strips If information is unavailable, please indicate why __________________ ________________
5	How many fentanyl test strips has your state/territory/tribal entity distributed since the last reporting period? ____ fentanyl test strips If information is unavailable, please indicate why _________________
6	How many first responders (e.g., law enforcement, emergency medical services, and fire department) has your state/territory/tribal entity trained on recognizing an opioid overdose and the appropriate use of naloxone overdose reversal kits since the last reporting period? ____ first responders If information is unavailable, please indicate why _________ ___________
7	How many key community sectors (e.g., family members, peers, military, criminal justice, community groups, and coalitions) has your state/territory/tribal entity trained on recognizing an opioid overdose and the appropriate use of naloxone overdose reversal kits since the last reporting period? ____ key community sectors If information is unavailable, please indicate why ______________________
8	How many people in your state/territory/tribal entity were educated on the consequences of opioid and/or stimulant misuse using strategic messaging (e.g. media campaigns, targeted social media content, and other similar strategies) since the last reporting period? ____ people If information is unavailable, please indicate why _______________ __________________
9	How many school-aged children in your state/territory/tribal entity received school-based prevention and education activities on the consequences of opioid and/or stimulant misuse since the last reporting period? ____ school-aged children If information is unavailable, please indicate why ___________________
10	How many people in your state/territory/tribal entity were trained to provide school-based prevention and education activities to school-aged children since the last reporting period? ____ people If information is unavailable, please indicate why _______________
11	How many people in your state/territory/tribal entity were educated on the consequences of opioid and/or stimulant misuse through prevention activities since the last reporting period? ____ people If information is unavailable, please indicate why __________________
12	How many people in your state/territory/tribal entity were reached through outreach activities that target underserved and/or diverse population (e.g., race, ethnicity, sex/gender, age, and disability status) to address the opioid and/or stimulant crisis since the last reporting period? ____ people If information is unavailable, please indicate why _________ ____________