Naugatuck Valley Health District
2019 Point of Dispensing Exercise

The Naugatuck Valley Health District will be hosting a Point of Dispensing (POD) exercise on Thursday June 27, 2019 at Shelton High School (120 Meadow Street, Shelton, CT 06484) from 8:30AM - 12:00PM to test its mass dispensing capabilities.

The hotwash will immediately follow the exercise and will be hosted at Naugatuck Valley Health District (98 Bank Street, Seymour, CT 06483) from 1:00PM - 2:00PM.

Please register for the event by completing this short survey. If you have any questions, please email Dave Heiden (dheiden@nvhd.org).

Thank you and we look forward to seeing you on exercise day!

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* 1. Please enter your contact information.

First and Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Do you have prescription authority?

Yes

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* 3. If representing a local health department/district, please enter below.

Naugatuck Valley Health District

Other (please specify)

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* 4. Are you representing a Medical Reserve Corps? If YES, please choose which unit you are from.

Other (please specify)

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* 5. Are you representing C.E.R.T.? If YES, please choose which team

Other (please specify)

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* 6. If your agency/organization has not been listed, please enter below.

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* 7. I am attending the POD exercise as a...

Player - POD Staff (must attend entire exercise)

Player - Mock POD Client (can come/go as available)

Evaluator

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* 8. I will be attending the hotwash after the exercise at Naugatuck Valley Health District beginning at 1:00PM (mandatory for all POD staff)

Yes

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100% of survey complete.