The Edgar County Public Health Department is conducting a Community Health Assessment Survey. The responses from this survey will determine the Health Department's areas of focus for the next 5 years. Your opinion matters! We appreciate you taking the time to respond. 

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* 1. In the following list, what do you think are the three most important factors for a “Healthy Community?” (Those factors which most improve the quality of life in a community.)

Check three:

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* 2. In the following list, what do you think are the three most important “health problems” in our community? (Those problems which have the greatest impact on overall community health.)

Check three:

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* 3. In the following list, what do you think are the three most important “risky behaviors” in our community? (Those behaviors which have the greatest impact on overall community health.)

Check three:

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* 4. How would you rate the overall health of our community?

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* 5. How would you rate your own personal health?

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* 6. How would you rate your oral health?

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* 7. How would you rate your overall family health?

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* 8. How many minutes per week do you spend exercising?

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* 10. Age:

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* 11. Sex:

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* 12. Ethnic group you most identify with:

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* 13. Marital Status:

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* 14. Education:

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* 15. Household Income:

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* 16. How do you pay for your health care? (check all that apply)

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* 17. Where/how you got this survey: (check one)

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* 18. Are you satisfied with the quality of life in our community? (Consider your sense of safety, well-being, participation in community life and associations, etc.)

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* 19. Are you satisfied with the health care system in the community? (Consider access, cost, availability, quality, and options in health care)

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* 20. Is this community a good place to raise children? (Consider school quality, day care, after school programs, recreation, etc.)

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* 21. Is this community a good place to grow old? (Consider elder-friendly housing, transportation to medical services, churches, shopping; elder day care, social support for the elderly living alone, meals on wheels, etc.)

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* 22. Is there economic opportunity in the community? (Consider locally owned and operated businesses, jobs with career growth, job training/higher education opportunities, affordable housing, reasonable commute, etc.)

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* 23. Is the community a safe place to live? (Consider residents’ perceptions of safety in the home, the workplace, schools, playgrounds, and parks. Do neighbors know and trust one other? Do they look out for one another?)

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* 24. Is there a sufficient number of mental health and social services in the community?

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