Baseline Survey of First Responders

The following survey will help the Lackawanna Opioid Coalition understand the type and amount of stigma currently residing in the attitudes and behaviors of first responders in our community.  Your answers from this survey will be kept confidential and will only be reported as a group.  The answers will indicate the type of training and education that will best reduce present stigma relating to opioid use disorder and overdoses amongst first responders.
 
Demographics

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* 1. Please indicate the date of survey:

Date / Time

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* 2. Please indicate your age:

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* 3. Please indicate your gender:

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* 4. Please indicate your race:

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* 5. Please indicate your highest completed level of education:

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* 6. Please indicate your first responder discipline:

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* 7. Please describe the majority of your shifts (select more than one if applicable):

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* 8. Please indicate the best description of the area in which you serve:

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* 9. Please indicate your length of time serving as a first responder:

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* 10. Please indicate your zip code of residence:

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