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* 1. In what county do you work?

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* 2. Do you live in a different county than you work?

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* 3. What type of position do you/did you hold at your current or last place of employment?

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* 4. What type of industry do you/did you work in?

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* 5. In the past 2 years, how often have you experienced negative impacts in your workplace due to co-worker(s) substance use?

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* 6. How much does substance use impact your current or former workplace?

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* 7. How much does substance use impact other workplaces in your city or region?

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* 8. How much does substance use impact the economy in your city or region?

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* 9. How much does substance use impact your industry in the region?

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* 10. Please rank which impacts have been the most serious in your workplace or other workplaces in your region, even if you think the issue is not very significant. (Rank 1-5, with 1 being not serious to 5 being the most serious.)

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* 11. Are there other impacts that concern you? Please describe:

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* 12. Have you personally experienced or observed any of the above impacts due, at least in part, to substance use?

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* 13. Have you ever had experience with or observed Vocational Rehabilitation providers at your workplace or assisting persons who work at your workplace?

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* 14. If you are an employer what are your barriers to hiring people with Substance Use issues? (choose all that apply)

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* 15. If you are an employer and interested in meeting job candidates in recovery, please share your contact information. (Leave blank if not interested or not an employer).

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* 16. If you are willing to consider participating in a follow-up session, please complete the following contact information. We want to hear from a good cross-section of employers, workers, people in recovery, and care providers to ensure we and our partners understand and work toward positive impacts for your region. Thank you! If definitely not interested leave blank.

Thank you for your help in completing this survey.  Our professional researcher will aggregate all of the participant answers so they cannot be linked to you.  If we use any of your comments in developing the Community Needs Assessment, we will not attribute them to you personally unless you give express permission.  Your participation is valued.

Please click "Done" to submit the survey.

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