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Fire/Police Special Needs Population Survey

1. Survey Directions

The Hamilton County General Health District is working with the Inclusion Network to identify individuals with special needs and mechanisms for reaching these groups in the event of an emergency. We understand that Police and Fire agencies are connected to their communities on a personal level and already respond to various types of emergencies involving special needs populations. As a first responder, we would like your input on the following nine questions. This survey should take approximately 5 minutes to complete. Please complete this survey no later than close of business Monday, July 24th. Thank you for you assistance.

	*  1. What city, township, or village do you work for?

	*  2. Do you work within the police department, fire department, or both? Police Fire Both Other (please specify)

	*  3. We have identified the following categories of individuals with special needs. For each category, please indicate approximately how many individuals with special needs you are aware of in your community.     1-5 6-19 20-49 50-100 >100 I don't know

	*  4. Please identify how you typically respond/communicate with the following groups.     Phone Call Personal Visit Letter Other

	5. If you checked other, please explain.

	*  6. We will be reaching out to organiztions that work with individuals with special needs in a variety of ways. Would your agency be one way in which we could communicate with these groups? For example, the health department may compile packets of information about sheltering in place. Would your agency be able to help distribute these materials to appropriate special needs populations in the community you serve? Yes No Other (please specify)

	7. If you answered YES to question above, who would be the primary contact person for this? Please list Name, Title, Phone, Fax, and Email

	*  8. What is the best way to reach this person? Email Phone Fax Other (please specify)

	9. Other comments:

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