Pueblo City Residential Survey/ FEMA Form 008-0-4

CSEPP Public Affairs IPT Questionnaire

OMB Control Number: 1660-0057

Expiration Date: 06/30/2011

PUEBLO CITY SURVEY

General Introduction…

S1. Hello, this is (FIRST AND LAST NAME) of CR Dynamics, working with the Department of Homeland Security and on behalf of Pueblo County Department of Emergency Management. We are not selling anything. We are conducting a survey among people living in your area. This survey has been approved by the Office of Management and Budget (OMB) under FEMA Information Collection 1660-0057 and has an estimated response time of 10 to 15 minutes.  Your participation is strictly voluntary and FEMA is not maintaining any personally identifiable information about you for this survey. Do you have a few minutes to answer a few questions?

S2. IF YES: Are you 18 years of age or older?

S3. IF YES: Start survey. IF NOT: Is there someone else I can talk to who is 18 years of age or older? If unavailable schedule callback and terminate.

S4. What city do you live in or closest to?

IF RESPONSE IS NOT ON THE LIST, READ THE LIST

1. Pueblo

2. Pueblo West

3. None of the above cities TERMINATE CALL

1. Do you know what the Chemical Stockpile Emergency Preparedness Program, also known as CSEPP (SEE-SEP), is?

1. Yes

2. No

2. Are you aware of the chemical agents at the Pueblo Chemical Depot?

1. Yes

2. No

3. How would you know if there were a chemical emergency at the Pueblo Chemical Depot? (DON’T READ, CATEGORIZE RESPONSE AS FOLLOWS, ACCEPT MULTIPLE RESPONSES)

1. Tone alert radio (TAR)

2. Siren/Loudspeaker

3. AM/FM radio

4. TV

5. Family

6. Friend

7. Work (Depot, police, fire)

8. Mobile sign board/Highway message board

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97. Other (PLEASE SPECIFY)

99. Don’t know

4. What actions would you take if you found out there was a chemical emergency at the Pueblo Chemical Depot? (DON’T READ, CATEGORIZE RESPONSE AS FOLLOWS, ACCEPT MULTIPLE RESPONSES)

1. Contact family/friends

2. Evacuate

3. Follow instructions/Do what told

4. Shelter in place

5. Turn on or listen to TV/AM/FM radio/TAR/EAS

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97. Other (PLEASE SPECIFY)

98. Nothing

99. Don’t know

5. Why do you say that? (DON’T READ, CATEGORIZE RESPONSE AS FOLLOWS, ACCEPT MULTIPLE RESPONSES)

CLARIFY IF RESPONDENT SAYS “THEY” OR “THEM”: Who do you mean by they/them?

1. To get away from the chemicals

2. To find out what to do/For more information

3. I don't know what else to do

4. It's the safest choice

5. I don't know enough about the chemicals

6. I learned it at work/training

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97. Other (PLEASE SPECIFY)

99. Don’t know

6. Do you or your family have an emergency plan?

1. Yes

2. No

7. How confident are you that you know how to shelter in place in the event of a chemical emergency?

SHELTER IN PLACE CLARIFICATION: Shelter in place is a protective action that involves taking cover in a home, business, or other permanent building.

If the respondent says “don’t know” say: “Please choose the one that most closely reflects your opinion.” (READ 1-4)

1. Very confident

2. Somewhat confident

3. Not very confident

4. Not confident at all

8. How confident are you that the public will be notified quickly in case of a chemical emergency at the Pueblo Chemical Depot?

If the respondent says “don’t know” say: “Please choose the one that most closely reflects your opinion.” (READ 1-4)

1. Very confident

2. Somewhat confident

3. Not very confident

4. Not confident at all

9. In the event of a chemical emergency at the Pueblo Chemical Depot, are you likely or unlikely to go within 10 miles of the depot?

WAIT AND ASK: Is that very likely/unlikely or somewhat likely/unlikely?

If the respondent says “don’t know” say: “Please choose the one that most closely reflects your opinion.” (READ 1-4)

1. Very likely GO TO 10

2. Somewhat likely GO TO 10

3. Somewhat unlikely GO TO 11

4. Very unlikely GO TO 11

10. Why do you say that? (RECORD VERBATIM RESPONSE)

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99. Don’t know

11. Does your work ever require you to go within 10 miles of the Pueblo Chemical Depot?

1. Yes GO TO 12

2. No GO TO 13

12. How often do you work within 10 miles of the Pueblo Chemical Depot? (READ 1–5)

1. At least once a week or more

2. Every two weeks to once a month

3. Every two months to a year

4. Fewer than once a year

5. (DON’T READ) Don’t know

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97. Other (PLEASE SPECIFY)

13. Do you have family or friends who live or work on or near the Pueblo Chemical Depot? (ACCEPT MULTIPLE RESPONSES)

1. Yes, family GO TO 14

2. Yes, friends GO TO 14

3. No, none GO TO 15

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97. Other (PLEASE SPECIFY) GO TO 15

14. What actions would you take to assist your family/friends who live or work near the Pueblo Chemical Depot during a chemical emergency? (RECORD VERBATIM RESPONSE)

IF RESPONDENT GIVES A RESPONSE SUCH AS “Anything I could” PLEASE ASK THEM TO FURTHER CLARIFY THEIR RESPONSE.

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99. Don’t know

To conclude, I have a few questions for statistical purposes

15. What is your approximate age, please? (READ 1–7)

1. 18–29

2. 30–34

3. 35–44

4. 45–54

5. 55–59

6. 60–64

7. 65+

8. (DON’T READ) Refused

16. Gender (BY OBSERVATION)

1. Male

2. Female

17. Is there anyone in your household whose first language is something other than English?

1. Yes

2. No (skip 35b and 35c)

17b. What is that language?

1. Spanish

2. Italian

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97. Other (PLEASE SPECIFY)

17c. Do you think your household would benefit by receiving emergency preparedness information in that language?

1. Yes

2. No

18. How long have you lived in the Pueblo City area? (READ 1–5)

1. Less than one year

2. 1-5 years

3. 6–10 years

4. 11–15 years

5. 16–20 years

6. More than 20 years

7. (DON’T READ) Don’t know/Refused

19. Do you have access to the Internet?

1. Yes………… Give internet address at the end of the survey

2. No…………. Don’t give Internet address at the end of the survey

20. Are you or any member of your household a member of the local emergency management or first responder community (fire, police, etc.)?

1. Yes

2. No

21. Are you or any member of your household employed by the Pueblo Chemical Depot or a contractor of the Depot?

1. Yes, Pueblo Chemical Depot

2. Yes, Contractor of Pueblo Chemical Depot

3. No

22. ZIP code (recorded in CATI from sample)

Thanks for your time—we really appreciate it.

Thanks again!