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1. Thank you for your time

In preparation for upcoming training, please take a few minutes to complete the following survey.  Your responses will be completely confidential. 

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* 1. What is your job title/role?

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* 2. Please respond to the following based on the level of contact you have/have had with individuals with the list of disabilities then your level of comfort. Your answers are Completely Confidential.

  Level of Contact Level of Comfort
Autism Spectrum
Cerebral Palsy
Epilepsy (including epilepsy first aid)
Hearing Loss-Deaf (use mainly sign language)
Hearing Loss-Hard of Hearing
Intellectual or Learning Disabilities 
Mobility Loss (upper & lower mobility)
Psychiatric Disabilities
Service Dogs (Real or questionable)
Speech Disabilities (speech impediments)
Vision Loss

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* 3. If you've assisted a resident and/or co-worker with a disability, please share how you effectively worked with them and/or what you might do differently next time.

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* 4. What question(s) would you like answered or issues discussed related to most effectively serving and/or working with those with disabilities?

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