HRMC EM Council- Document Warehouse

Exit Survey »

What is your full name?

What is your job title(s)?

What is the highest level of education you have achieved?

Less than high school degree

High school degree or equivalent (e.g. GED)

Some college but no degree

Associate degree (e.g. AA, AS)

Bachelor's degree (e.g. BA, AB, BS)

Master's degree (e.g. MA, MS, MBA)

Professional degree (e.g. MD, DDS, JD)

Doctorate degree (e.g. PhD)

Indicate any clinical degree's or other certifications that you hold

Please indicate your willingness to respond to an emergency on your off duty hours?

Not willing to respond

Depends on the time of day

Very likely to respond

It's part of my job responsibility to respond

How far away do you live from Hackettstown Regional Medical Center on average?

0-10 Minutes

10-25 Minutes

25-40 Minutes

40 or More Minutes

Please indicate the number of family members who cantake the following medications in the event of a CBRNE event. Please use each star to represent each family member ONCE.

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BOTH

NONE