Red Badge E-pack: Medical First Responders Survey Form

CBS 5 RED BADGE E-PACK PROGRAM

MEDICAL FIRST RESPONDERS SURVEY FORM Your cooperation in completing and mailing this survey will be helpful in evaluating the effectiveness of the CBS 5 RED BADGE E-PACK PROGRAM. You may also access www.azgohs.gov to respond to this survey. Thank you - GOHS 1. Was the information on the personal card helpful? __YES __NO If NO, please briefly state why?_________________________________________ __________________________________________________________________ 2. Was your experience with the CBS Red Badge E-Pack program:  Excellent (skip Question #3 and go to #4)  Needs Improvement (skip Question #4) 3. If it needs improvement, please briefly state what could be improved based on this particular experience. Please be as specific as possible.______________ ___________________________________________________________________________________________ __________________________________________________________________ 4. If you answered Excellent in #2, please briefly state what made this experience altogether excellent? Please be as specific as possible. __________________ __________________________________________________________________ Encuesta para los primeros en responder a la emergencia (personal medicó).

The Honorable

Jan Brewer

GOVERNOR Arizona Department of Public Safety Arizona Governor’s Office Of Highway Safety

Mail Drop #3800