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HHI Healthcare Workers Kit Survey
Thank you for receiving the Healthcare Worker Kit from Heart to Heart International! Our goal is to provide healthcare workers with tools to be better prepared to provide care if a disaster impacts your local community. We intend to continue distributing these kits to other healthcare workers and would appreciate your feedback! Please take a few minutes to help us understand the benefits of this kit and/or how we can improve it.
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1.
What is your role in the healthcare field?
(Required.)
Community Health Worker
Mental Health Provider
Nurse (RN, LPN, MA)
Medical Provider (MD, DO, PA, NP)
Other (please specify)
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2.
What is your gender?
(Required.)
Female
Male
Transgender Woman
Transgender Man
Non-Binary
Prefer not to say
*
3.
What is your Race/Ethnicity?
(Required.)
American Indian/Alaska Native
Asian/Pacific Islander
Black/African American
Hispanic/Latino
White/Caucasian
Prefer not to say
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4.
How long have you been in the healthcare workforce?
(Required.)
Less than 1 year
More than 1 year
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5.
Have you ever been personally impacted by a disaster?
(Required.)
Yes
No
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6.
Where did you receive this kit?
(Required.)
Name of Health Facility
City
State
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7.
With the Healthcare Workers Kit in hand, do you feel better prepared to continue to provide care if a disaster impacts your local community?
(Required.)
Did not help my feeling or preparedness
Slightly increased my feeling of preparedness
Helped me to feel more prepared
Greatly increased my feeling of preparedness
Did not help my feeling or preparedness
Slightly increased my feeling of preparedness
Helped me to feel more prepared
Greatly increased my feeling of preparedness
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8.
Please help us understand how useful each item was
(Required.)
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Backpack
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Basic First Aid Kit
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
DripDrop/Hydration Salt Packets
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
N95 Masks
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Gloves
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Seatbelt Cutter/Window Breaker Emergency Escape Tool
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Multi-Tool
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Emergency Whistle
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
LED Headlamp
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Insect Repellant
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
Universal Charging Cable
This item helps me feel more prepared for a disaster
This item does not help me feel more prepared for a disaster
9.
Are there any items that you would suggest
adding
to the kit?
10.
Are there any items that you would suggest
removing
from the kit?
11.
Is there any additional feedback positive or negative you would like to share with us?