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* 1. Company/Organization Name

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* 2. Your Name

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* 3. Email address

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* 4. Please describe the health facility for which you work:

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* 5. Please describe your position within the
organization:

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* 6. How satisfied are you with your
organization’s current ability to recruit and
retain the trained health care professionals
necessary to effectively complete your
mission?

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* 7. What challenges do you face in
recruiting staff? (check all that apply)

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* 8. Of the challenges you checked, which two are the most significant?

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* 9. Which of the following hinders hiring? (check all that apply)

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* 10. What challenges do you face in retaining employees? (Check all that apply)

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* 11. Of these retention challenges, which two are most significant for your organization?

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* 12. Currently, what are your most difficult to fill positions?

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* 13. What contributes to making these positions difficult to fill?

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* 14. Looking forward, what (if any) additional or new recruitment challenges do you anticipate? (New offerings being added, etc.)

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* 15. Does your organization currently offer clinical opportunities for schools / students?

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* 16. In what fields/departments do you offer clinical opportunities?

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* 17. How satisfied are you with hosting the clinical experiences?

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* 18. Do the clinical experiences offer a meaningful pipeline for recruitment of new employees?

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* 19. What (if any) suggestions do you have for schools / training programs to improve the clinical experience for your organization?

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* 20. Do you currently have a preceptor training program?

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* 21. Do you currently offer an externship or other school-to-work program?

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* 22. Do you offer scholarships or other education assistance for current employees to attend school to advance their education / career?

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* 23. Does your organization offer internal training programs?

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* 24. Please estimate the annual turnover rate in entry-level skills jobs at your organization.

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* 25. How many job openings do you anticipate in the next 12 -24 months?

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* 26. Does your company utilize the public workforce programs for recruitment and screening?

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* 27. Do you have restrictions on hiring some targeted populations, such as ex-offenders?

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* 28. What percentage of your workers do not have a high school equivalency?

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* 29. What percent of your workers have a declared disability?

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* 30. What (if any) educational programs would you like to see created or expanded locally by colleges, universities or Career Tech centers?

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* 31. Would your organization be interested in local education providers offering continuing education programs that your employees could attend?

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* 32. Beyond workforce development, what other major issues concern your organization? (Please list all that apply)

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* 33. Would your organization be interested in participating in regional collaborative lobbying or advocacy efforts to address these concerns?

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* 34. Please list any other thought, concern or suggestion you may have regarding health field workforce development.

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* 35. What industry associations do you belong to? (Please list all that apply.)

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