Question Title

* 1. Where were you when the incident occurred?

Question Title

* 2. Did you experience any of these symptoms (Select all that apply)?

Question Title

* 3. How long after onset did you wait before you or someone took action to get you help?

1 hour 1 day 1 week
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 4. Who took you to the hospital?

Question Title

* 5. What was the outcome of the event?

Question Title

* 6. Type of firefighter

Question Title

* 7. What is your age?

Question Title

* 8. We'd appreciate your contact information so we may follow up with you. 

0 of 8 answered
 

T