volunteer H1N1 survey

Question Title

* 1. How did you hear about the volunteer opportunity for H1N1 vaccine clinics at the schools?

Employer e-mail

Employer phone call/voice mail

A friend/acquaintance let me know about the opportunity

School requested assistance

Placer County website

Newspaper

Radio

Other (please specify)

Question Title

* 2. Why did you choose to volunteer?

Enjoy volunteering

Wanted to help my child's school

Wanted to help insure H1N1 vaccines were available

Wanted to be at the clinic where my child/children would receive the vaccine

Wanted to help the PTC/PTA

Wanted to share my expertise

Other (please specify)

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* 3. Do you have children enrolled in a Placer County School (k-12th grade)?

yes

Question Title

* 4. Did your child/children receive a H1N1 vaccine at a school clinic?

Yes

Question Title

* 5. If yes to #4, which school district did your child/children receive a H1N1 vaccine (please check all that apply.)

Ackerman Charter

Alta-Dutch Flat

Auburn Union

Colfax

Dry Creek

Eureka Union

Other

Foresthill Union

Loomis Union

Newcastle

Placer County Office of Ed

Placer Union

Rocklin Unified

Roseville City

Roseville Joint Union

Tahoe Truckee Unified

Western Placer Unified

Horizon Charter

Private School

Other (please specify)

Question Title

* 6. Please rate the following components you were involved with during the H1N1 vaccine clinic(s) you attended

	Needs Improvement	Acceptable	Well Done	N/A
Communication with Placer County staff	Communication with Placer County staff Needs Improvement	Communication with Placer County staff Acceptable	Communication with Placer County staff Well Done	Communication with Placer County staff N/A
Training	Training Needs Improvement	Training Acceptable	Training Well Done	Training N/A
Forms and Paperwork	Forms and Paperwork Needs Improvement	Forms and Paperwork Acceptable	Forms and Paperwork Well Done	Forms and Paperwork N/A
General information regarding the H1N1 vaccine	General information regarding the H1N1 vaccine Needs Improvement	General information regarding the H1N1 vaccine Acceptable	General information regarding the H1N1 vaccine Well Done	General information regarding the H1N1 vaccine N/A
Organization of clinic	Organization of clinic Needs Improvement	Organization of clinic Acceptable	Organization of clinic Well Done	Organization of clinic N/A
Customer service provided by Placer County staff	Customer service provided by Placer County staff Needs Improvement	Customer service provided by Placer County staff Acceptable	Customer service provided by Placer County staff Well Done	Customer service provided by Placer County staff N/A
Support from County staff	Support from County staff Needs Improvement	Support from County staff Acceptable	Support from County staff Well Done	Support from County staff N/A
Resolution of problems and/or challenges	Resolution of problems and/or challenges Needs Improvement	Resolution of problems and/or challenges Acceptable	Resolution of problems and/or challenges Well Done	Resolution of problems and/or challenges N/A
Site of the clinic	Site of the clinic Needs Improvement	Site of the clinic Acceptable	Site of the clinic Well Done	Site of the clinic N/A
Length of the clinic	Length of the clinic Needs Improvement	Length of the clinic Acceptable	Length of the clinic Well Done	Length of the clinic N/A
Communication after the clinic	Communication after the clinic Needs Improvement	Communication after the clinic Acceptable	Communication after the clinic Well Done	Communication after the clinic N/A
Overall impression	Overall impression Needs Improvement	Overall impression Acceptable	Overall impression Well Done	Overall impression N/A

Other (please specify)

Question Title

* 7. Both before and during the clinic, did you have the information you needed to complete the task(s) you were assigned to?

yes

unsure

Other (please specify)

Question Title

* 8. Please rate the following questions

	excellent	good	poor
Overall, how would rate the entire volunteer experience from beginning to end?	Overall, how would rate the entire volunteer experience from beginning to end? excellent	Overall, how would rate the entire volunteer experience from beginning to end? good	Overall, how would rate the entire volunteer experience from beginning to end? poor

Other (please specify)

Question Title

* 9. Would you volunteer for a County run clinic again?

yes

unsure

Other (please specify)

volunteer H1N1 survey

1. Default Section

Question Title

* 1. How did you hear about the volunteer opportunity for H1N1 vaccine clinics at the schools?

Question Title

* 2. Why did you choose to volunteer?

Question Title

* 3. Do you have children enrolled in a Placer County School (k-12th grade)?

Question Title

* 4. Did your child/children receive a H1N1 vaccine at a school clinic?

Question Title

* 5. If yes to #4, which school district did your child/children receive a H1N1 vaccine (please check all that apply.)

Question Title

* 6. Please rate the following components you were involved with during the H1N1 vaccine clinic(s) you attended

Question Title

* 7. Both before and during the clinic, did you have the information you needed to complete the task(s) you were assigned to?

Question Title

* 8. Please rate the following questions

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* 9. Would you volunteer for a County run clinic again?

Question Title

* 10. Please feel free to share any additional comments