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Fire Service Needs Assessment

Please complete this survey to help us understand your needs as a member of the fire service and the needs of your community. The information gathered in this survey will not be shared and is only for the use of Triage Cancer to learn how to best serve you. Thank you for your time!

If you have any questions about Triage Cancer or this survey, please email us at info@TriageCancer.org.
1.Please provide your fire department email address to verify your service and to be entered into a drawing for one of four $50 gift cards. You will be sent an email to your personal email if you win.(Required.)
2.Please provide your personal email address.(Required.)
3.Last Name(Required.)
4.Are you a: (check all that apply)(Required.)
5.What is your service rank?(Required.)
6.What is your service specialty: (click all that apply)
7.Which state do you live in?(Required.)
8.What is the name of your Fire Department?(Required.)
9.How many years have you been in the fire service?(Required.)
10.What is your average number of hours worked per week?(Required.)
11.About how many fire service personnel are there in your department?(Required.)
12.How comfortable do you feel in answering questions on how to keep working, or take time off, if needed for medical treatment?(Required.)
13.What is the primary source of your health insurance benefits?
14.How knowledgeable are you about health insurance options offered by your department? (e.g., HMO, PPO, dependent coverage, retiree coverage, post employment plans, FSAs)
15.How comfortable are you in choosing the best health insurance plan for you and your family?
16.Did your department explain the line of duty packet or Personal Information Packet (PIP)?
17.Did you complete the line of duty packet or PIP?
18.How comfortable are you that you have all of the estate planning documents you need?
19.How knowledgeable are you about the appropriate cancer screenings for members of the fire service?
20.How comfortable are you with steps to take if your health insurance denies coverage for you care (e.g., screenings, prescriptions, other treatment)?
21.When looking for information to understand the health care benefits offered by your department, where do you begin your search?
22.Would you be interested in any of the following opportunities? Check all that apply. (If yes, please make sure to provide your email above.)
23.Is there anything else you think Triage Cancer should know about the issues fire service personnel and their families are facing?
24.What types of resources do you find most helpful for you? (e.g. animated videos, podcasts, printed materials, classes)
25.If you connected with Triage Cancer at an event, please indicate the name of the event. (e.g., FDIC, Science to the Station, FCSN Symposium)
26.What is your current education level?(Required.)
27.What gender do you identify as?(Required.)
28.Please specify your ethnicity.(Required.)
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