We are interested in the types of services you provide, whether or not you work with people who are in crises because of a disaster and who those people might be.  Please respond to the following three questions.  Thank you.

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* 1. How would you describe your primary service/work setting?

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* 2. 2. In your role, as described in Question 1, approximately how many hours per month do you provide some level of care, support, or professional interaction with persons who are, or have been, in a crisis (disastrous) situation within the previous 30 days? (Consider this definition of crisis: a sudden calamitous event bringing intense instability, damage, or danger, especially one with the distinct possibility of a highly undesirable outcome. Examples range from the person, or a loved one of the person, being a victim of crime, suffering a house fire, experiencing a sudden serious illness or accident, a tornado, or a wildfire.)

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* 3. Considering your answers to Questions 1 and 2 above, to what percentage have you provided some level or care, support or professional interaction with person who are--

The total must equal 100%

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* 4. Date Completed

Date

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