Emergency Response After-Action Survey
Please complete this survey to help us evaluate and improve our emergency response efforts. Your feedback is valuable for future preparedness.
Responder Name
*
First Name
Last Name
Role During Emergency Response
*
Please Select
Incident Commander
Team Leader
Responder
Logistics
Medical Staff
Other
Date of Emergency Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Emergency Event
*
Type of Emergency
*
Please Select
Fire
Flood
Medical Emergency
Hazardous Material
Severe Weather
Other
Please rate the following aspects of the response:
*
Rows
Excellent
Good
Fair
Poor
Response Time
1
2
3
4
Team Coordination
5
6
7
8
Communication
9
10
11
12
Resource Availability
13
14
15
16
Safety Procedures
17
18
19
20
How effective was the communication during the response?
*
Not Effective
1
2
3
4
Highly Effective
5
1 is Not Effective, 5 is Highly Effective
What challenges or obstacles did you encounter during the response? (Select all that apply)
Lack of resources
Communication breakdowns
Unclear roles/responsibilities
Safety concerns
Access issues
Other
What worked well during the emergency response?
What could be improved for future responses?
Overall, how would you rate the success of the emergency response?
*
1
2
3
4
5
Submit Survey
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