R2 Children's Health Survey

OMB Number 2010-0042
EPA ICR Number 2434.65

EPA Region 2 Children’s Health Training Survey

This survey will help us design the most useful trainings and outreach materials for you on Children’s Environmental Health issues. We would like to know your area of work, what you would like to know more about, and what information you currently share or would like to share with your community and those you serve. All responses are confidential and will not be used for any other purpose except described here.

* Required

Email*: __________________________________

Sector*: Please select the one that corresponds closest to your work.

___ General Public Health

___ Child Care

___ Schools

___ Healthcare/Medical Provider

___ Research

___ Community Organization

Organization*: ____________________________

Position Title: ____________________________

1) Select all of the topics you would like to learn more about*:

___Air quality and asthma (including outdoor and indoor air pollution)

___Pesticides (including pesticide use at home and schools and take-home exposures from agricultural workers)

___Climate & health

___Lead exposure (from environmental and cultural sources)

___Mercury (from fish and cultural/personal care products)

___Pre-conception and pre-natal environmental exposures – Women’s Health

___Drinking water (municipal, bottled, and from private wells)

___Other topics (please specify, or write none if none of these):_______________________

2) Would trainings be more useful if CEUs (Continuing Education Units) were offered, and which would you require?* (Mark all that are relevant)

___ MCHES/CHES credits (Master/Certified Health Education Specialists)

___ CPH (Certified Public Health Professionals)

___ CME (Continuing Medical Education)

___ Other (Please provide:___________________)

___ CEUs not necessary

3) How far would you be willing/able to travel for a free training you are interested in?* (Mark one)

___ Up to 15 minutes

___ Up to 30 minutes

___ Up to 1 hour

___ Up to 2 hours

___ Online trainings only

4) If offered, would you be interested in a monthly or quarterly email newsletter from EPA Region 2 on the following topics?* (Mark one)

___ Children’s Environmental Health and Schools

___ Environmental Justice

___Both combined

___Neither