Healthcare Climate Questionnaire Form
Help us understand how climate-related conditions are affecting your healthcare operations. Please answer the following questions about your facility's experiences, challenges, and preparedness.
Facility Name
*
Facility Location (City, State/Region, Country)
*
Type of Healthcare Facility
*
Please Select
Hospital
Clinic
Long-term Care
Urgent Care Center
Specialty Center
Other
Which climate-related conditions has your facility experienced in the past 12 months?
*
Extreme heat
Flooding
Wildfires/smoke
Storms/hurricanes
Drought
Other
Have any climate-related events disrupted your facility's operations in the past year?
*
Yes
No
If yes, please describe the main operational impacts experienced (e.g., power outages, supply chain issues, patient surges).
How prepared is your facility for future climate-related events?
*
Very prepared
Somewhat prepared
Not prepared
Which preparedness measures are currently in place at your facility?
*
Emergency response plan
Backup power systems
Staff training for climate emergencies
Infrastructure upgrades (e.g., flood barriers)
None
Other
What additional resources or support would help your facility address climate-related challenges?
Additional comments or feedback
Submit
Should be Empty: