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QPR Pre-Survey
Please complete this section before completing QPR Training. Thank you!
1.
Age
15-17
18-20
21-24
25-44
45-64
65 and over
2.
Gender
Male
Female
Trans male
Trans female
Gender non-conforming
3.
Race
White
Black or African American
Native Hawaiian/Other Pacific
Asian or Asian American
American Indian or Alaska Native
More than one race
Other race
4.
Ethnicity
Hispanic
Non-Hispanic
5.
Sector:
Behavioral Health/Prevention
State/Local Government
Healthcare
Faith-Based Oganization
Civic/Volunteer Organization
Law Enforcement
Youth Serving Organization
Schools
Media
Business
Parents
Youth
Other
6.
How would you rate your knowledge of suicide in the following areas?
Low
Medium
High
Facts concerning suicide prevention:
Low
Medium
High
Warning signs of suicide:
Low
Medium
High
How to ask someone about suicide:
Low
Medium
High
Persuading someone to get help:
Low
Medium
High
How to get help for someone:
Low
Medium
High
Information about local resources for help with suicide:
Low
Medium
High
7.
What is your comfort level talking about suicide?
Very comfortable
Comfortable
Neutral
Uncomfortable
Very uncomfortable
8.
Would you be likely to ask someone "are you thinking of killing yourself" if you are concerned about them?
Always
Sometimes
Never
9.
Please rate your level of understanding about suicide and suicide prevention:
High
Medium
Low
