Public Health Crisis Preparedness Survey
Please complete this survey to help us assess your organization's preparedness for public health emergencies.
Full Name
*
First Name
Last Name
Organization Name
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Organization
*
Please Select
Hospital
Clinic
Public Health Department
School/University
Long-term Care Facility
Other
Does your organization have a written emergency preparedness plan for public health crises?
*
Yes
No
In Development
How confident are you in your organization's ability to respond to a public health crisis?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which resources does your organization have readily available for emergencies? (Select all that apply)
*
Personal Protective Equipment (PPE)
Medical Supplies (medications, ventilators, etc.)
Emergency Communication Tools
Trained Emergency Response Staff
Isolation/Quarantine Facilities
Other
How often does your organization conduct emergency preparedness drills or training?
*
Please Select
Monthly
Quarterly
Annually
Rarely/Never
Does your organization have a communication plan for notifying staff and the public during a crisis?
*
Yes
No
In Development
What are the greatest challenges your organization faces in preparing for a public health crisis?
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