1. General Information

50% of survey complete.

This CONFIDENTIAL survey will help MITSS better serve you and others enduring the stress after an adverse event. There are 14 questions included in this survey. Your participation is greatly appreciated. This is a CONFIDENTIAL survey that will take approximately 5 to 10 minutes to complete. Please feel free to answer openly and honestly as your responses will help MITSS to provide information and support more effectively.

* 1. Are you male or female?

* 2. Age?

* 3. What role did you have in the event?

* 4. What type of an event was it?

* 5. When did the event occur?

* 6. Were you referred to confidential support services?

* 7. If yes, what services were you offered?

* 8. Were you referred to services at the place the event occurred (in house) or were you referred to outside services?

* 9. Please check any of the following you have experienced/ are experiencing after the event.

* 10. Please indicate any of the following you have experienced in the past 3 months, not otherwise explained by a known medical condition:

* 11. Please indicate any of the following that you have experienced in the past 12 months:

* 12. After the event, were you able to take a work-sanctioned break to regroup prior to caring for others?

* 13. Please feel free to add any additional information you would like to share with MITSS, including any feedback regarding this survey or your personal event.

* 14. If you would like a MITSS support staff to contact you, please leave your contact information below. This survey does not automatically record any identifying or contact information. Therefore, it is important that you leave such confidential information in order for a support staff member to contact you.