Form 1 Epi X Customer Survey

Attachment 3.

Epi-X Customer Survey

FORM APPROVED

OMB No. 0920-0636

EXP DATE MM/DD/20YY

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0636).

Epi- X Customer Survey

Epi- X Customer Survey

On <date>, Epi-X sent an emergency notification. To help CDC improve the rapid notification system, we need your feedback.

1. How did you first receive the emergency notification?

• Work telephone

• Cell phone

• Home phone

• Voice mail

• Pager

• From a colleague

• Did not learn of it

• Other (e.g., answering service)

• If “Other,” explain how.

2. Where were you when you first received the emergency notification?

• At work

• At home

• In transit

• Did not learn of it

• Other

• If “Other,” explain where.

3. How did you respond to the emergency notification? Select all that apply.

• Logged on to Epi-X

• Called a telephone number from a numeric pager message

• Called a colleague

• Did not respond

• If you did not respond, why not?

• Other

• If “Other,” explain how.

4. If you received the emergency notification by numeric pager, you should have received a telephone number to call. If you called the telephone number provided, was your call answered on the first attempt?

• I did not receive a numeric pager message.

• The call was answered the first time.

• I had to call two or more times.

• The call was not answered.

• I did not call back to the notification system.

• Comment on your experience.

5. From which computers or devices do you routinely access Epi-X?

• Work computer

• Home computer

• Laptop

• Mobile device (e.g., BlackBerry)

• If “Mobile device,” specify which mobile device.

• Other

• If “Other,” explain which computer.

6. Do you have other computers from which you want to access Epi-X?

• Yes

• No

7. What is your opinion of the Epi-X emergency notification system?

• Very Satisfactory

• Satisfactory

• No opinion

• Unsatisfactory

• Very Unsatisfactory

• Explain your answer and/or suggest improvements.

8. What is your opinion of the voice messaging system?

• Very Satisfactory

• Satisfactory

• No opinion

• Unsatisfactory

• Very Unsatisfactory

• Explain your answer and/or suggest improvements.

9. Do you have a mobile device (e.g., BlackBerry, IPhone, SmartPhone) from which you want to access Epi-X?

• Yes

• No

• If “Yes,” what type of mobile device do you have?