OMB No. __0920-XXX__
Exp. Date _xx/xx/20xx_
Study ID # _______
This survey asks about your department’s fire and life safety education (FLSE). FLSE is defined as community fire and injury prevention programs and activities designed to eliminate or reduce situations that endanger lives, health, property, or the environment. DIRECTIONS: Check the correct answer or write in your answer, as requested. |
1. How long have you been the fire chief here? |
Number of years: _______ |
2. How long have you been in the fire service? |
Number of years: _______ |
3. What is your department’s overall annual operating budget (including both personnel and non-personnel)? |
Budget:$ _________________ |
4. What percentage of this budget is devoted to FLSE (including both personnel and non-personnel)? |
Percent budget: ______ % |
5. Do you have any other sources of financial support for your FLSE (ex: grants or donations)? |
____No ____Yes |
6. Do personnel in your department conduct FLSE activities? Personnel = all paid and/or volunteer staff. |
____No Go to Question 27 ____Yes Answer 6A below |
A. Who conducts FLSE activities? Check all that apply. |
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_____Uniformed personnel assigned exclusively to FLSE _____Non-uniformed personnel assigned exclusively to FLSE _____Uniformed personnel assigned to both FLSE and other responsibilities _____Non-uniformed personnel assigned to both FLSE and other responsibilities _____Fire Corps _____Volunteers _____Other, Specify: _____________________________________________________ |
7. On average, what is the total number of hours of FLSE per week conducted by your department? |
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____Less than 5 hours ____Between 5-9 hours ____Between 10-19 hours ____Between 20-29 hours |
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_____Between 30-39 hours _____Between 40-49 hours _____50 hours or more |
8. How familiar are you with NFPA 1035: Standard for Professional Qualifications for Public Fire and Life Safety Educator job performance requirements?
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_____Never heard of it/don’t know _____Heard of it, do not know details _____Somewhat familiar _____Very familiar |
9. Does your department require general training in FLSE for all new department recruits (not just FLSE personnel)? |
_____No _____Yes |
10. Does your department require specialized training for any personnel whose primary responsibility is FLSE? |
_____No Answer 10A below _____Yes Answer 10B below |
Check all that apply.
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_____No FLSE educators in department _____Not a priority _____No funds available _____No training programs available _____Other, Specify: ___________________ |
B. Who conducts this training? Check all that apply.
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_____National Fire Academy, on/off campus _____State agencies or organizations _____Your department _____Other, Specify: ___________________ |
11. Does your department require certification for any personnel whose primary responsibility is FLSE? |
____No Answer 11A below ____Yes Answer 11B below |
Check all that apply.
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_____No FLSE educators in department _____Not a priority _____No funds available _____Other, Specify: ___________________ |
Check all that apply.
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_____NFPA 1035 _____Child passenger safety training _____Other, Specify: ___________________ |
12. How is FLSE positioned in your department?
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_____Not important part of department activity _____Supplementary to other department activity _____Important part of department activity _____Critical part of department activity |
13. What FLSE activities does your department participate in or provide? Check all that apply. |
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_____Elementary school presentations _____Middle or junior high school presentations _____High school presentations _____College/university presentations _____Older adult presentations _____Risk Watch® _____Learn Not to Burn® _____Parent-Teacher Association presentations _____Juvenile firesetting programs _____General health and/or safety fairs |
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_____Home safety inspections _____Workplace safety inspections _____Fire Prevention Week/Fire Safety Month events _____Babysitter preparation training _____Child passenger safety seat checks/installs _____Neighborhood canvassing or sweeps to promote smoke alarms _____Other smoke alarm programs (maintenance, installation, response to requests) _____Other, Specify: ________________________ |
14A. About how many FLSE activities does your department do in a typical year? (Please write in an actual number, not a range.) |
Number:_________ per year |
14B. About how many people does your department reach with your FLSE activities in a typical year? (Please write in an actual number, not a range.) |
Number:_________ per year |
14C. About what percentage of FLSE activities are:
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______% per year ______% per year |
15. What is the focus or content of your FLSE activities? Of the time your department spends on FLSE, what percentage is spent on each topic? Check all that apply. |
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a. Fire prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Burn prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Fire escape planning. . . . . . . . . . . . . . . . . . . . . . . . . d. Carbon monoxide detectors. . . . . . . . . . . . . . . . . . . e. Fire extinguishers. . . . . . . . . . . . . . . . . . . . . . . . . . . f. First aid or CPR. . . . . . . . . . . . . . . . . . . . . . . . . . . . g. Smoke alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. Home fire sprinkler systems. . . . . . . . . . . . . . . . . . . i. Juvenile firesetting. . . . . . . . . . . . . . . . . . . . . . . . . . j. Disaster preparedness. . . . . . . . . . . . . . . . . . . . . . . . k. Public health emergencies. . . . . . . . . . . . . . . . . . . . l. Technology issues (ex: interconnected alarms). . . . . . . . . . . . . . . . . . . m .Other, Specify: ___________________________ |
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Focus? Percent of time? _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
_____ _____ _____ _____ |
16. Does your department provide FLSE activities that target any of the following specific high- or special-risk audiences? |
_____No Go to Question 17 _____Yes Answer 16A below |
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A. Which high- or special-risk audiences do you target? Check all that apply. |
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_____Children under the age of 5 _____College/university student housing _____Older people _____People with disabilities |
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_____People living in poverty _____People with low literacy skills _____People for whom English is a second language _____Other, Specify: _________________________ |
17. Does your department partner with any of the following community groups to support, deliver or promote FLSE? |
_____No Go to Question 18 _____Yes Answer 17A below |
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A. Who do you partner with? Check all that apply. |
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_____Schools/classroom teachers _____Hospitals and/or burn units _____Public health departments _____Health and safety researchers _____Faith-based leaders _____Businesses/employers _____Senior centers |
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_____Police departments _____Civic organizations (ex: Kiwanis, Rotary) _____Community coalitions (ex: Safe Kids, Injury Free) _____Public housing authority/apartment managers _____Community agencies (ex: Red Cross, AHA, ALA) _____Youth groups (ex: Scouts, Boys & Girls Clubs) _____Other, Specify: ____________________________ |
18. Does your department develop or distribute educational materials (ex: brochures, videos, flyers, posters)? Check all that apply. |
_____No Go to Question 19 _____Yes, We distribute others’ materials Answer 18A below _____Yes, We create/distribute our own materials Answer 18A below |
A. About how many materials do you distribute? |
Number:_____ per year |
19. For each of the following safety products, please tell us if your department distributes and/or installs them and about how many your department distribute and/or installs per year. Check all that apply. Distribute # Install # |
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a. Lithium battery smoke alarms....................................................... b. Conventional smoke alarms.......................................................... c. 9-volt batteries (replacement batteries)......................................... d. Smoke alarms for deaf/hard-of-hearing........................................ e. Carbon monoxide detectors........................................................... f. Fire escape ladders......................................................................... g. Fire extinguishers.......................................................................... h. Car safety seats or booster seats.................................................... i. Bicycle helmets.............................................................................. j. Other, Specify:_______________________________________ |
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ |
20. Does your department charge a fee for any of your FLSE activities, educational materials, or products? Check all that apply. |
_____No _____Yes, for activities _____Yes, for materials _____Yes, for products |
21. How does your department work with the news media (including newspapers, television, and radio)? Check all that apply. _____We do not work with the media _____We have a public information officer (PIO) who handles media contacts _____Fire personnel, other than a PIO, work with the news media _____We conduct media campaigns on FLSE _____We partner with other groups to conduct media campaigns |
22. Does your department promote fire-related laws, ordinances, or regulations by testifying, presenting information to legislators, working with coalitions, or in any other ways? Check all that apply. |
_____No Go to Question 24 _____Yes, at the local level _____Yes, at the state level _____Yes, at the national level |
23. What topics does your department promote? Check all that apply. |
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_____Smoke alarms _____Home fire sprinkler systems _____Fire sprinklers for non-residential settings _____Building or fire code provisions _____Carbon monoxide detectors _____Fire safe cigarettes |
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_____Children’s sleepwear _____Primary seat belt laws _____Bicycle or motorcycle helmet laws _____Fireworks _____Child passenger safety seats _____Other, Specify: ________________________ |
24. Does your department evaluate your FLSE activities in any of the following ways? |
_____No Go to Question 25 _____Yes Answer 24A below |
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A. How do you evaluate your FLSE activities? Check all that apply. |
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_____Debriefing after FLSE activities _____Informal feedback from participants _____Pre-/post-tests of participants _____Public opinion surveys _____Home safety observations |
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_____Injury/loss statistics _____Tracking number of participants or activities _____Tracking number of materials or products _____Other, Specify: _______________________ |
25. Overall, how satisfied are you with the FLSE conducted by your department? (Place an “X” anywhere on the line that best represents your satisfaction; 0 = very dissatisfied and 100 = very satisfied.) ___________________________________________________________________________ 0 10 20 30 40 50 60 70 80 90 100 |
26. How does your department use local or state fire incident data for your FLSE activities? Check all that apply. |
_____We do not currently use it _____We use it to identify neighborhoods at high-risk _____We use it to identify people/groups at high-risk _____We use it to plan programs and outreach _____We use it for evaluation purposes _____We use it for public presentations _____Other, Specify: __________________________ |
27. Does your department participate in the National Fire Incident Reporting System (NFIRS)? |
_____No _____Yes |
SECTION III: The purpose of this last section is to find out what would make it easier for your
department to conduct Fire and Life Safety Education (FLSE).
28. Please tell us how helpful each of the following would be to your department. |
Not at All Very Helpful Helpful |
a. Information about funding FLSE activities..................................................... b. Continuing education for FLSE programs and policies.............................. c. Directory of “best practice” FLSE programs and policies.............................. d. Free community educational materials........................................................... e. Free safety products to distribute.................................................................... f. Partnerships with national health and safety organizations............................. g. Partnerships with local or state public health departments............................. h. Information about NFPA 1035 requirements for FLSE.................................. i. Website for FLSE ideas, model programs, evaluation ideas, etc............................. j. Listserv (email communication program to discuss FLSE ideas with other depts).... k. Access to experts on implementing proven educational programs................. l. Access to experts on program evaluation......................................................... m. Access to experts on new fire safety technologies......................................... n. Other, Specify:_______________________________________________ |
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29. Below is a list of possible barriers to conducting FLSE identified by other fire departments. Please tell us how much of a barrier each would be for your department. |
Not a Significant Barrier Barrier |
a. No FLSE specialist in my department............................................................ b. Not enough FLSE personnel in my department.............................................. c. Not enough training/expertise among FLSE personnel.................................. d. Not enough known about FLSE programs that work..................................... e. Lack of mandate to do FLSE.......................................................................... f. Lack of time to do FLSE................................................................................. g. Little commitment to FLSE by department superiors.................................... h. Little commitment to FLSE by department personnel................................... i. Not enough funding for FLSE......................................................................... j. Lack of recognition for doing FLSE................................................................ k. Too many competing priorities in the department.......................................... l. Other, Specify:________________________________________________ |
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30. How interested are you in FLSE training for your department? |
_____Not interested _____Somewhat interested _____Very interested |
31. Please write in the three FLSE topics for training that are of most interest to your department.
1________________________________________________________________________________________
2________________________________________________________________________________________
3________________________________________________________________________________________ |
32. Please tell us how desirable each training format would be for your department. |
Not Very Desirable Desirable |
a. Printed materials (ex: curricula, books, articles).......................................... b. In-person presentation by FLSE expert........................................................ c. Workshop at your department...................................................................... d. Video, CD or DVD...................................................................................... e. Internet course.............................................................................................. f. National Fire Academy course, on campus.................................................. g. National Fire Academy course, off campus................................................. h. National training conference with networking opportunities...................... i. State or local training conference with networking opportunities................ j. Other, Specify:_______________________________________________ |
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33. Would your department be able to pay for any of these types of training? |
_____No _____Not sure _____Yes |
34. Please describe any additional prevention activities that your department does.
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35. In completing this survey, did you |
_____Complete it by yourselfGo to Question 35 _____Complete it with input from anotherAnswer 34A _____Ask someone else to complete it Answer 34A
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A. Please write in that person’s job title:
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____________________________________________ |
Thank you for completing this survey!
Using the stamped envelope provided, please return to:
Jennifer Piver-Renna, JH Bloomberg School of Public Health, 624 N. Broadway, Room 531, Baltimore, MD, 21205
or – fax to (410) 614-2797.
You may also request an electronic copy of the survey from jpiver@jhsph.edu
© Johns Hopkins University
File Type | application/msword |
File Title | Injury Prevention & Partnership Activities in Trauma Centers |
Author | Sandra Tietelbaum |
Last Modified By | fmc7 |
File Modified | 2007-11-05 |
File Created | 2007-11-05 |