SRT PRE-DEPLOYMENT QUESTIONNAIRE
© 2012, 2015

CONFIDENTIAL PRE-DEPLOYMENT QUESTIONNAIRE

INTRODUCTION:

Providing care and support in the immediate aftermath of disaster can be an enriching professional and personal experience that enhances satisfaction through helping others. It can also be physically and emotionally exhausting.

Sometimes people volunteer without thoroughly considering whether or not engaging in disaster relief work is really appropriate for them at the time. This is why we would like you to take a few minutes now and complete this questionnaire.

If you find yourself answering the questions below in such a way as to lead a reasonable person to conclude that perhaps you should not deploy today then we urge you to recognize this possibility and discuss it with the Staging Liaison, your Team Leader and/or your Unit Coordinator.

Remember, it is always better to be safe than sorry.

PHYSICAL & EMOTIONAL HEALTH CONSIDERATIONS

Being sufficiently physically and emotionally healthy are two crucial factors for a successful deployment. Take a moment and consider the following.

Question Title

* 1. Have you had any of these conditions in the past 12 months? (Yes=1; No=0)

Anemia

Asthma or allergies

Arthritis or rheumatism

Serious back trouble

Chronic bronchitis

Cancer

Diabetes

Heart trouble

High blood pressure

Kidney trouble

Stroke

Stomach or duodenal ulcer

Other physical ailments

Depression

Anxiety

Other psychological and/or substance abuse problems

Question Title

* 2. Do you believe that you are physically and emotionally healthy enough to complete this deployment? (Yes=0; I don’t know=1; No=2)

Yes

I don't know

Question Title

* 1. Have you had any of these conditions in the past 12 months? (Yes=1; No=0)

Question Title

* 2. Do you believe that you are physically and emotionally healthy enough to complete this deployment? (Yes=0; I don’t know=1; No=2)

Question Title

* 3. Total Score PHYSICAL & EMOTIONAL HEALTH CONSIDERATIONS