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Learn more about Epi-Ready and other trainings and resources
Thank you for your interest in Epi-Ready training! Please complete the form below to request information about receiving an Epi-Ready training.
Additional resources can be found at:
NEHA | Food Safety
Food Safety Centers of Excellence
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1.
Applicant Information
(Required.)
Your Name:
Your Job Title:
Your Agency:
Your Agency's Physical Address:
City:
County:
State:
Zip Code:
Phone Number:
Email Address:
2.
Point of Contact Information, only if different than applicant.
Name:
Job Title:
Agency:
Phone Number:
Email Address:
*
3.
What is the population size served by your agency?
(Required.)
1,000-4,999
5,000-9,999
10,000-24,999
25,000-49,999
50,000-99,999
100,000-249,999
250,000-499,000
More than 500,000
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4.
Which of the following best describes your agency type?
(Required.)
State
Tribal
Local
Territorial
Other (please specify)
*
5.
Which of the following best describes your agency’s governance structure?
(Required.)
Centralized or largely centralized structure: Local health units are primarily led by employees of the state.
Decentralized or largely decentralized structure: Local health units are primarily led by employees of local governments.
Mixed/Hybrid structure: Some local health units are led by employees of the state, and some are led by employees of local government. No single structure predominates.
Not sure
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6.
Do you plan to invite others to the training, what type of agency are the others associated with? Select all that apply.
(Required.)
State
Tribal
Local
Territorial
None of the above
Other (please specify)
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7.
How many attendees are expected to attend the Epi-Ready training? (Please note that 40 people is generally the maximum number)
(Required.)
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8.
Have you reached out previously about the need for this training to NEHA, Food Safety Centers of Excellence, or the CDC?
(Required.)
Yes
No
If Yes, please identify the organization who was contacted:
*
9.
Has your agency previously received any Epi-Ready Training?
(Required.)
Yes
No
If Yes, what month/year was the Epi-ready Training provided and by what organization?
*
10.
Please describe who will be attending the training. Check all that apply. (Please note that generally a mix from all disciplines is most effective).
(Required.)
Epidemiologists
Environmental Health Specialists
Laboratory Specialists
Other, please provide job titles and/or agency names:
*
11.
Does your agency currently use a foodborne illness complaint system?
(Required.)
Yes
No
Not sure
If Yes, please provide type of complaint system:
*
12.
Does your agency currently possess a stool collection kit?
(Required.)
Yes
No
Not sure
If Yes, will someone in attendance at the Epi-Ready Training be willing to demonstrate proper use of the kit? Please provide name and email address.
*
13.
Please enter confirmation of the full physical street address, and any space details, of where the Epi-ready Training will take place.
(Required.)
Location Name
Physical Street Address
City
County
State
Zip Code
Provide any additional details of the space:
14.
Please provide any additional comments or information we may need to know regarding this request for Epi-ready Training.
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