Sample Survey Questions

1. BEFORE receiving this toolkit, this faith based community was prepared for preventing the spread
of infection by:
a. Encouraging hand washing (ex. placing instructional signs in places such as bathrooms and
where food is prepared or consumed)
b. Encouraging cough etiquette (ex. placing instructional signs in common places)
c. Encouraging alternatives to handshaking
d. Suspending the use of the common cup
e. Encouraging members to stay home when ill
f. Disinfecting nursery toys and surfaces
g. Teaching children about hand washing and cough etiquette
h. Having hand sanitizer available
i. None of the above

2. AFTER receiving this toolkit, this faith based community will use the following resources to
obtain information about how to prevent the spread of disease and plan for a public health
emergency:
a. Centers for Disease Control
b. State Public Health Department
c. Local Public Health Department
d. National, Regional, State office of your organization
e. Scholarly articles
f. Other_________________________________________________
g. We will not use any resources to prepare for the spread of disease or a public health
emergency

3. Please check the appropriate box. Did you find the toolkit:
Strongly Agree Neutral Disagree Strongly
Agree Disagree
(5) (4) (3) (2) (1)
4. L
i
Easy to use s
t
Organized (Colored tabs)

Confusing

Convenient (Info in one location)

Overwhelming

Missing Information
two things that this faith based community could do to reduce the spread of disease:
A. __________________________________________________________________

_____________________________________________________________________

B. _________________________________________________________________

_____________________________________________________________________