Key Informant/Stakeholder Questionnaire

Form Approved

OMB Control No.: 0920-xxxx

Expiration Date: xx/xx/xxxx

Key Informant/Stakeholder Survey

Questions 1-10 intended for use prior to participants using/having exposure to hazard assessment, mapping and planning (RAMP) Tool.

1. Name:

2. Jurisdiction: (Name); (Dropdown) City, County, State, Other

3. Type of Agency: (Dropdown) Government, Community-Based, Faith-Based, etc.

4. If Government, What type of services does your agency provide? (Dropdown) Public Health, Health Services, EMS (if different from Health Services), Mental Health, Emergency Management, Social Services, other.

5. Level of Government: Federal, State, Local

6. Has your agency ever conducted a hazard vulnerability assessment (HVA) or jurisdictional risk assessment (JRA)? (Yes/No)

   1. If “Yes” to Q.6: When was the last time your agency conducted a HVA or JRA? (Year)

   2. In your opinion, how accurate was your HVA/JRA at representing your jurisdictions hazard based priorities?

7. Did your jurisdiction develop or adjust any hazard/threat specific emergency response plans as a result of the HVA/JRA?

8. Do you feel that your jurisdiction (community) is at risk for specific hazards?

   1. If so, which ones? (list)

   2. Why do you think your jurisdiction is at risk for this (these) hazards?

9. (Referring to Q.8a) Do you think that your jurisdiction is at greater risk for these hazards than similar jurisdictions, either geographically or service sector specific?

   1. If so, why do you think your jurisdiction is at greater risk for these hazards?

10. Do you believe that the risk for negative health consequences (impacts) associated with a specific hazard can be reduced (“mitigated”) by developing response plans specific to that hazard?

CDC estimates the average public reporting burden for this collection of information as 60 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).

11. Do you believe it is important for local and state agencies to develop hazard/threat specific semergency response plans? (Yes/No)

    1. If “Yes” to Q.11: Why do you feel that way?

    2. If “No” to Q. 11: Why do you feel that way?

12. Does your agency have response plans developed for specific threats or hazards?

    1. If “Yes” to Q.12: Did your local health and medical (ESF 8) stakeholders provide input and feedback into the development of threat/hazard specific response plans?

    2. How was that input from health and medical stakeholders solicited and received?

    3. If “Yes” to Q.12a: How much input would you say your local emergency management, law enforcement, and/or fire agency (ies) provided into the development of your agency’s threat/hazard specific response plans? (low, medium, high, very high)?

    4. How was that input from emergency management, law enforcement and/or fire agency stakeholders solicited and received?

Demonstration/Use of RAMP Tool:

13. Do you feel that your jurisdiction (community) is at risk for specific hazards?

    1. If so, which ones? (list)

    2. Why do you think your jurisdiction is at risk for this (these) hazards?

14. (Referring to Q.8a) Do you think that your jurisdiction is at greater risk for these hazards than geographically or demographically similar jurisdictions?

15. Do you believe that the risk for negative health consequences (impacts) associated with a specific hazard can be reduced (“mitigated”) by developing response plans specific to that hazard?

16. Do you believe it is important for local and state agencies to develop hazard/threat specific emergency response plans? (Yes/No)

    1. If “No” to Q. 11: Why do you feel that way?

17. Thinking about the RAMP Tool, do you think this Tool is effective at assessing health risk and consequences in your jurisdiction?

    1. If “Yes”: Why?

    2. If “No”: Why not?

18. Do you think or feel differently about the importance of health and medical emergency response planning in your jurisdiction?

    1. Why/Why not?

19. Thinking about the Tool’s scenarios, did you think the scenarios were a helpful part of the RAMP Tool?

    1. If “Yes”: Why?

    2. If “No”: Why not?

20. Were the scenarios appropriate/applicable to you, your agency and your jurisdiction?

    1. If “Yes”: Why?

    2. If “No”: Why not?

21. What would you change about the scenarios included in the RAMP tool?

22. Thinking about the Tool’s Analysis and Mapping of At-Risk Populations feature, did you think these features were a helpful part of the RAMP Tool?

    1. If “Yes”: Why?

    2. If “No”: Why not?

23. Were the Analysis and Mapping of At-Risk Populations features/approach appropriate/applicable to you, your agency and your jurisdiction?

    1. If “Yes”: Why?

    2. If “No”: Why not?

24. What would you change about the Analysis and Mapping of At-Risk Populations feature/approach in the tool?

25. At the end of the assessment process, the Tool produced a prioritized ranking of hazards and threats specifically related to your jurisdiction. Do you feel that this prioritized ranking is helpful to your jurisdiction?

    1. Why/Why Not?

    2. If not, what features or changes—in either the tool or the risk assessment—could be improved to make the tool more useful to you and your jurisdiction?

26. Was the tool easy to use and/or intuitive?

    1. If “Yes”: Why?

    2. If “No”: Why not?

27. What did you like about the User’s Interface?

28. What did you not like about the User’s Interface?

29. Considering the tool as a whole, what changes would you like to see to improve its value to you as an emergency manager, to your agency, to your community? (Open-ended Discussion)

30. What aspects of the Tool did you like?

    1. Why?

31. What aspects of the Tool do you feel need to be adjusted/improved upon to make it more applicable, robust or usable by local health and emergency response agencies? (List and Discussion)

32. What other last thoughts, comments or recommendations do you have for making the RAMP Tool better, easier to use, or more effective? (Open-ended Discussion)