* 1. What is your role at your organization?

* 2. What is the size of your organization?

* 3. Which of the following services would you consider important for your organization? Please rank in order with 1 being the highest importance.

  1 2 3 4 5
Education on HICS materials
HICS Training reinforced with exercise for hospital
Exercises with community involvement
Consultation for assessment and development of plans
Other

* 4. What type of emergency preparedness training would best serve the needs of your organization? Please rank in order with 1 being the highest importance.

  1 2 3 4 5 6
HICS incorporation into Emergency Operations Plan
Internal tabletop exercises
Drills
Full scale
Community exercises
Other

* 5. Of the below items, which focus areas would your organization seek assistance with? Please rank in order with 1 being the highest importance.

  1 2 3 4 5 6 7 8
Basic HICS (HICS concepts and tools, HICS Management Team design, alignment with NIMS)
Advanced HICS (HICS implementation strategies, Incident Action Planning, training, incorporation into organization, tabletop exercise)
Development of Emergency Operations Plan
96 hour stand-alone capabilities
Contingency plans based on Hazard Vulnerability Assessment
Community response integration
Train the trainer programs
Other

* 6. Which incident types do you need training for your organization? Please rank in order with 1 being the highest importance.

  1 2 3 4 5 6 7
Highly Infectious Disease
Active Shooter
Evacuation
Mass Casualty
Communication
National Planning Scenarios (Pandemic Influenza; Natural Disaster; or Attack from Cyber, Chemical, Biological, Radiological, Nuclear, or Explosives)
Other

* 7. Who would be the target audience for the training? Please rank in order with 1 being the highest importance.

  1 2 3 4 5 6
Executive leadership / Administrators
HICS leadership positions (Incident Commander, Safety Officer, Public Information Officer, Liaison Officer, Section Chiefs)
All staff with defined roles in HICS/HIMT in emergency response
All staff positions in organization
Internal and external emergency response partners
Other

* 8. What delivery method of training would best serve the needs of your organization? Please rank in order with 1 being the highest importance.

  1 2
Class room
Distance learning

* 9. What would you consider the most suitable length for training classes at your organization for in-person Class Room Instruction? Please rank in order with 1 being the highest importance.

  1 2 3 4 5
< 2 hour
< 4 hour
< 6 hour
< 8 hour
Other

* 10. What distance is acceptable to travel for training? Please rank in order with 1 being the highest importance.

  1 2 3 4 5 6 7 8
Local
Within 100 miles
Within region
Within state
Within US
Prefer training to be part of national conference
Adminstration is not willing to send staff away to training
Other

* 11. What would you consider the most suitable length for training classes at your organization for Distance, Self-paced Learning? Please rank in order with 1 being the highest importance.

  1 2 3 4 5
< 2 hours
< 4 hours
< 6 hours
< 8 hours
Other

* 12. What amount of time would be appropriate for various staff for initial HICS training?

  2 hours 4 hours 5 hours 6 hours 8 hours 12 hours
Administrator
Physician
HICS Personnel
Clinical Personnel
Nonclinical Personnel

* 13. What amount of time would be appropriate to various staff for refresher HICS training?

  1 hour 2 hour 3 hour 4 hour
Administrator
Physician
HICS Positions
Clinical Personnel
Nonclinical Personnel

* 14. Do you have a funding source for HICS training?

* 15. Where is your organization located?

* 16. Are you interested in HICS education for offsite locations? (Please specify: e.g., clinics, nursing homes, corporate headquarters)

* 17. If you wish to comment further about the HICS survey or HICS materlals; or want to contact the HICS Board, please leave your comment and/or contact information.

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