Crisis Feedback Survey
Please share your experiences and feedback regarding the recent crisis event. Your input will help us improve our response and support.
How would you like to identify yourself?
*
I prefer to remain anonymous
I am willing to provide my name
Your Full Name (leave blank if you prefer to remain anonymous)
First Name
Last Name
Your Email Address (optional, for follow-up if needed)
example@example.com
Which type of crisis are you providing feedback on?
*
Please Select
Natural disaster (e.g., earthquake, flood, hurricane)
Public health emergency
Security incident
Technological disruption
Other
How were you affected by the crisis? (Select all that apply)
*
Physical impact (injury, displacement, etc.)
Emotional or psychological impact
Financial impact
Disruption of services (utilities, communication, etc.)
Other
How would you rate the crisis response?
*
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
What worked well during the crisis response?
What could be improved in future crisis responses?
Submit Feedback
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