Exit Impacts of Substance Use on Work Survey Question Title * 1. In what county do you work? Question Title * 2. Do you live in a different county than you work? No Yes If "yes" in what county do you live? Question Title * 3. What type of position do you/did you hold at your current or last place of employment? Management Supervisor Professional (non-supervisor) Frontline Worker Other Not employed in last 2 years Question Title * 4. What type of industry do you/did you work in? Manufacturing Construction Services (retail/sales) Restaurant Education Health Care or Behavioral Health Transportation Distribution Other (please specify) Question Title * 5. In the past 2 years, how often have you experienced negative impacts in your workplace due to co-worker(s) substance use? Every day Very often Often Seldom Never N/A Have not worked in the past 2 years Comments Question Title * 6. How much does substance use impact your current or former workplace? No impact Very little impact A small impact A significant impact A serious impact N/A Have not worked in the past 2 years Comments Question Title * 7. How much does substance use impact other workplaces in your city or region? No impact Very little impact A small impact A significant impact A serious impact Comments Question Title * 8. How much does substance use impact the economy in your city or region? No impact Very little impact A small impact A significant impact A serious impact Comments Question Title * 9. How much does substance use impact your industry in the region? No impact Very little impact A small impact A significant impact A serious impact Comments Question Title * 10. Please rank which impacts have been the most serious in your workplace or other workplaces in your region, even if you think the issue is not very significant. (Rank 1-5, with 1 being not serious to 5 being the most serious.) Question Title * 11. Are there other impacts that concern you? Please describe: Question Title * 12. Have you personally experienced or observed any of the above impacts due, at least in part, to substance use? Yes No If yes, please briefly describe the impacts: Question Title * 13. Have you ever had experience with or observed Vocational Rehabilitation providers at your workplace or assisting persons who work at your workplace? Yes No Not sure If yes, please briefly describe the experience/observation and any outcomes you noticed: Question Title * 14. If you are an employer what are your barriers to hiring people with Substance Use issues? (choose all that apply) Training Soft Skills Failed pre-employment drug screens Company Policies N/A Not an employer Other (please specify) Question Title * 15. If you are an employer and interested in meeting job candidates in recovery, please share your contact information. (Leave blank if not interested or not an employer). Name Company Email Address Phone Number Question Title * 16. If you are willing to consider participating in a follow-up session, please complete the following contact information. We want to hear from a good cross-section of employers, workers, people in recovery, and care providers to ensure we and our partners understand and work toward positive impacts for your region. Thank you! If definitely not interested leave blank. Name Email Address Phone Number Thank you for your help in completing this survey. Our professional researcher will aggregate all of the participant answers so they cannot be linked to you. If we use any of your comments in developing the Community Needs Assessment, we will not attribute them to you personally unless you give express permission. Your participation is valued.Please click "Done" to submit the survey. Done