INDIVIDUAL & DEPARTMENT INFORMATION

* 1. Currently, I am: (select all that apply)

* 2. What is your age?

* 3. Which race/ethnicity best describes you? (Please choose only one.)

* 4. Please select you gender.

* 5. Which of the following best describes your current relationship status?

* 6. What is the highest level of education you have completed?

* 7. Do you work another job another than in your role as a first responder?

* 8. What is your current status related to the military?

* 9. How many years have you been an EMT and/or paramedic? (If not applicable, leave blank)

* 10. How many years have you been a firefighter? (If not applicable, leave blank)

* 11. At what age did you start as an EMT/paramedic or firefighter?

* 12. What is the shift structure like where you work as a first responder?

* 13. FOR FIREFIGHTERS ONLY: What is your current rank? (If not a firefighter, please skip to Question 15)

* 14. FOR FIREFIGHTERS ONLY: Does an ambulance service currently run out of your fire department?

* 15. In which region of the state of Arkansas do you work as a first responder? (To enlarge the map, hold down "CTRL" and hit the +/= button on your keyboard).

* 16. In which type of setting do you work as a first responder?

* 17. Which type of department/ unit do you work for?

* 18. What is the size of your department/ unit?

* 19. In your first responder role, have you ever responded to a suicide attempt or death? (select all that apply)

* 20. MEDICAL HISTORY: Have you ever been diagnosed with any of the following medical problems? (Check all that apply)

* 21. Have you ever been diagnosed with a mental health problem?

* 22. Have you ever received treatment for a mental health problem?

* 23. Do you now, or have you ever, taken medications for a mental health problems?

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