Prevention Survey

OMB CONTROL NUMBER: 0704-0610
OMB EXPIRATION DATE: 03/31/2025
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-0610, is estimated to
average 1.25 hours per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding the burden estimate or burden reduction
suggestions to the Department of Defense, Washington Headquarters Services, at whs.mcalex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that
notwithstanding any other provision of law, no person shall be subject to any penalty for failing
to comply with a collection of information if it does not display a currently valid OMB control
number.

Prevention Survey

Please list your installation or ship name: _____________________

Instructions

The purpose of this survey is to assess the expertise needed to conduct primary prevention with military
Service members. Primary prevention efforts aim to prevent Service members from dying by suicide;
misusing alcohol; assaulting, harassing or bullying others; and engaging in interpersonal violence through
programs, education and training, evaluation studies and other activities.
No one person is expected to have expertise in all areas; however, understanding your expertise can help
determine how you can best contribute to a larger prevention team. For each item in the survey, you will be
asked to rate how knowledgeable you are and how relevant it is to your job or position. There are no right
or wrong answers, please just answer based on your experience.

Section 1: Primary Prevention

Rate how knowledgeable you are about each item from 1 (No knowledge) to 5 (Extensive
knowledge/expertise) and how relevant each item is to your job or position from 1 (Not relevant) to 5
(Central to my job or position).
1. Define prevention and describe the associated core concepts such as primary, secondary, and tertiary
prevention
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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2. Explain the importance of cross-agency collaboration and the role that different agencies, organizations
and disciplines within the military (e.g., SAPRO, victim advocates, equal opportunity officers) and with
external individuals and organizations play in preventing suicide and harmful behaviors like alcohol
misuse, domestic violence, sexual assault, and harassment before they occur
None

1

2

3

4

5

Extensive

Knowledge
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Relevance
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3. Articulate how the goals, target audience, and facilitator skillsets differ for response efforts versus
primary prevention efforts
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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4. Describe the influence of risk factors for suicide and harmful behaviors like alcohol misuse, domestic
violence, sexual assault and harassment across multiple levels: individual (e.g., sex), relationship
(e.g., abusive intimate relationship), community or organization (e.g., general tolerance of harmful
behaviors), societal (e.g., weak laws)
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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5. Describe the influence of protective factors for suicide and harmful behaviors like alcohol misuse,
domestic violence, sexual assault and harassment across multiple levels: individual (e.g., emotional
health), relationship (e.g., communication skills), community or organization (e.g., lack of tolerance of
harmful behaviors), societal (e.g., strong laws and positive norms)
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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Continue on to next page

6. Explain how data can be used to identify emerging risks at my installation (e.g., spikes in prevalence of
sexual assault)
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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7. Describe key sources of data (e.g., workplace surveys, incident databases)
across the Department of Defense, and for specific components and installations and describe their
strengths and weaknesses
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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8. Choose and justify an evidence-based prevention activity based on characteristics of the intended
audience
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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9. Distinguish between prevention activities that are evidence-based and those that are not
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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10. Understand the multiple key elements of effective prevention practice (e.g., varied teaching methods)
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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11. Describe the importance of evaluation and why and when evaluation should be done
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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12. Develop a long-term plan for prevention and identify issues that may impact the goals and sustainability
of the plan
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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13. Describe ways that prevention of one type of harmful behavior (e.g., sexual assault) can be integrated
into other prevention efforts (e.g., alcohol and drug prevention, other violence prevention) and identify
common barriers to integration
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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14. Communicate evaluation findings (e.g., what changed, in whom, by how much, what this means for
your program)
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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Continue on to next page

15. Identify key military policies, laws or regulations that address suicide, harmful behaviors like alcohol
misuse, domestic violence, sexual assault and harassment and their prevention
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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16. Demonstrate a trauma-informed approach when delivering sensitive prevention content
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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17. Identify and describe training resources, conferences, and courses that would be appropriate for learning
new information on sexual assault prevention strategies, research, and best practices
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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18. Identify key professional organizations and agencies within and outside the military that are related to
prevention and describe how these organizations can assist in maintaining and developing prevention
skills
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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Section 2: Service Member Engagement

Rate how knowledgeable you are about each item from 1 (No knowledge) to 5 (Extensive
knowledge/expertise) and how relevant each item is to your job or position from 1 (Not relevant) to 5
(Central to my job or position).
19. Demonstrate the ability to present data in a clear and understandable manner for different audiences
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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20. Identify potential prevention offices/partners (within and outside the installation) and resources to assist
in conducting an evaluation
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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21. Foster mutually respectful interactions between Service members and leadership at your installation
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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22. Convey what your prevention efforts are trying to promote (e.g., safe and respectful environments) in
addition to what these efforts are trying to prevent (e.g., sexual assault)
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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Continue on to next page

23. Demonstrate the ability to prepare different types of culturally appropriate written documents (e.g.,
written testimony, public health brief, fact sheet, press release, letter to the editor, policy statement,
website content, etc.) to effectively communicate information about prevention
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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24. Work with Service members in such a way that they have meaningful input into decisions about
prevention activities
None
1
2
3
4
5
Extensive
Knowledge
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Relevance
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Section 4: Demographics

Below are a few questions about your background. This information is used to help characterize the group
of individuals responding to this survey and will not impact your anonymity.
25. Age
26. Sex

27. Hispanic

28. Service
29. Component
30. Paygrade (select one)
E1-E4
E5-E6
E7-E9
O1-O3
O4-O6 or above
W1-W3
W4-W5
Prefer not to respond
GS, fill in
number:

Continue on to next page

〇

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Man

Woman

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Yes
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No
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Prefer not to
respond
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Prefer not to
respond
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Air Force

Army

Navy

Marine Corps

Space Force

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Active

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Natl Guard

Reserve

DoD Civilian

31. Education
Some HS
HS Diploma/GED
Some college/no degree
2 yr. college
4 yr. college
> 4 yr. college
Prefer not to respond

Other; please describe: _____________________

N/A

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N/A

32. Race/Ethnicity

Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of
Barrow lnupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

D Asian -

Provide details below.

□ Chinese
□ Vietnamese

□ Asian Indian
□ Korean

Japanese

Enter, for example, Pakistani, Hmong, Afghan, etc.

D Black or African American African American

Provide details below.

□ Jamaican

Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese, etc.

D Hispanic or Latino Mexican

Cuban

Provide details below.

□ Puerto Rican
□ Dominican

□ Salvadoran
□ Guatemalan

Enter, for example, Colombian, Honduran, Spaniard, etc.

D Middle Eastern or North African Lebanese

Syrian

□ Iranian
□ Iraqi

Provide details below.

□ Egyptian
□ Israeli

Enter, for example, Moroccan, Yemeni, Kurdish, etc.

Native Hawaiian
Tongan

□ Samoan

Enter, for example, Chuukese, Palauan, Tahitian, etc.

D White -

Provide details below.

English

Italian

□ German
□ Polish

□ Irish
□ Scottish

Enter, for example, French, Swedish, Norwegian, etc.

Thank you!