Form 0920-24GC Initial Survey

[OS] CDC/ATSDR Formative Research and Tool Development

AttA - Immediate Post Exercise Survey

[CPR] This is a T.E.S.T.

OMB: 0920-1154

Document [docx]
Download: docx | pdf

Attachment A: 2024 Survey-Immediate Follow-up


Form Approved

OMB Approval No. 0920-1154

Expiration Date: 03/31/2026

Survey - Immediate Follow – UpShape1

Thank you for participating in a This is a TEST activity. Your voluntary participation in this survey will help CDC evaluate and improve the quality of this tool and learn how to better implement future designs. All results from the survey are anonymous unless you would like us to contact you for additional follow up. If you would like additional follow up, you may provide your name and professional email at the end of the survey.

  1. My role in an emergency response is,

  1. Communications/ PIO (Public Information Officer)

  2. Emergency management

  3. Environmental protection

  4. Fire/ Police/ Hazmat

  5. Hospital

  6. Public health

  7. Radiation control

  8. Volunteer organization

  9. Other, please specify


  1. During an emergency response what level does your role support

  1. Federal

  2. State

  3. Local

  4. Tribal

  5. Territorial

  6. Municipal


Responder background

Please provide your background prior to this activity


  1. My knowledge of public health emergency response related to [Community Reception Centers (CRCs) and Radiological emergencies/Points of Dispensing (PODS)/Incident command functions] was,

  1. no knowledge

  2. some knowledge

  3. moderate level of knowledge

  4. significant level of knowledge

Shape2

Public reporting burden for this collection of information is estimated to be 15 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 Reports Clearance Officer; Paperwork Reduction Project (0920-0527); M.S. D-24; 1600 Clifton Road NE, Atlanta, Ga. 30333.


  1. My experience with [radiation emergency response/Points of Dispending during a response/ Incident Command structure] was,

  1. no experience

  2. some experience

  3. moderate level of experience

  4. significant level of experience


  1. My knowledge of [Community Reception Centers (CRCs) and Radiological emergencies/Points of Dispensing (PODS)/Incident Command] operations was,

    1. no knowledge

    2. some knowledge

    3. moderate level of knowledge

    4. significant level of knowledge


  1. My experience with [CRC/POD/ Incident Command] operations was,

    1. no experience

    2. some experience

    3. moderate level of experience

    4. significant level of experience


  1. My participation with tabletop exercises consists of,

    1. no experience

    2. participating as an observer

    3. assuming one or more roles

    4. planning and facilitating


Skip pattern: Questions 8-11 are SKIPPED by people who respond “a” for question 7

  1. I am satisfied with my previous tabletop exercise experiences.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. Tabletop exercises generally are engaging and keep my attention.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree



  1. I feel more prepared for an actual response or full-scale exercise after a tabletop exercise:

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. My general impression on the usefulness tabletop exercises is: (open)


  1. My experience with full-scale exercises is,

    1. No experience

    2. Some experience

    3. Moderate experience

    4. Significant experience


Skip pattern: Questions 13-15 are SKIPPED by people who respond “a” for question 12

  1. I am satisfied with my previous full-scale exercise experiences.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree

  2. Full scale exercises generally are engaging and keep my attention.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. I feel more prepared for an actual response after a full-scale exercise:

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. My experience with actual response is (this includes but is not limited to COVID-19, natural disasters)

a. No experience

b. Some experience

c. Moderate experience

d. Significant experience


  1. In general, I enjoy board games

  1. No

  2. Yes

  3. Depends on the game


  1. A board game that I enjoy and why would be: (open)


  1. My experience with cooperative board exercise/games is:

    1. No experience

    2. Some experience

    3. Moderate experience

    4. Significant experience


  1. Prior to this activity, had you heard about This is a TEST? If so, how did you hear about it?

    1. No

    2. Yes, STLT partner

    3. Yes, conference or webinar

    4. Yes, Other, please specify


Gameplay, Exercise Satisfaction and Applied Learning

Please provide feedback on the gameplay, exercise satisfaction and applied learning


  1. Now that I’ve played the game, my confidence in my ability to anticipate needs [at a CRC/at a POD/using Incident Command Structure] has,

    1. Remained the same

    2. improved by 20%

    3. improved by 40%

    4. improved by 60%

    5. improved by 90%


  1. I am satisfied with the game.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. I felt I was able to apply previous public health or response knowledge and/or skills in the game.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree

  6. No Previous [CRC/POD/ICS] Knowledge


After playing the game:

  1. I better understand my role (played) at a [CRC/POD/ in the ICS structure].

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. I better understand other roles at a [CRC/POD/ in the ICS structure].

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. I have a greater understanding of [CRC/POD/ICS] operations.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. I feel more prepared for a full-scale exercise or response.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree



  1. I feel empowered to exercise a [CRC/POD/ICS] after playing this game.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


Exercise Format

  1. The exercise/game suited my learning style.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. This format for learning may be beneficial for training others.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. I feel this was a valuable experience that was different from a traditional tabletop exercise or workshop.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. In your opinion, what was gained from this exercise format that is different than other formats? (Open)


  1. I would recommend this game to a colleague.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. I would like to play this game again.

    1. Strongly disagree

    2. Disagree

    3. Neutral

    4. Agree

    5. Strongly Agree


  1. What other type of emergency response, if any, would you like this format to be used? (Select all that apply)

  • Chemical emergency

  • Heat emergencies

  • Hurricane/Extreme Storms

  • Infectious Disease Outbreak Response

  • PODs (Vaccine and/or Pill Dispensing)

  • Radiation emergency/CRC

  • Sheltering

  • Wildfire

  • Other, please list


  1. What level(s( of government do you think this tool is appropriate for (Select all that apply)?

  • Federal

  • State

  • Local

  • Tribal

  • Territorial

  • Municipal

  • Other


  1. What audience(s) do you think this tool is appropriate for (Select all that apply)?

  • Emergency planners and managers

  • Decision and policy makers

  • Community reception center/Points of Dispensing staff

  • Incident Command Leadership

  • Other, (please specify)


Exercise Design and Engagement

Please provide feedback on exercise design and engagement


  1. The exercise/game design is attractive.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. This exercise/game was engaging and kept my attention.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. The exercise/game facilitated cooperation and collaboration

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. This exercise/game facilitated discussion among players

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. The exercise/game provided realistic scenarios and discussions.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


The exercise/game accurately simulated (applies to Q43-Q45):

  1. Bottlenecks and resource needs

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. Individual needs and population anxiety

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. Limited staffing and fatigue

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. The exercise/game addressed planning and knowledge gaps.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. I was able to identify gaps in my plans and actions to take.

  1. Strongly disagree

  2. Disagree

  3. Neutral

  4. Agree

  5. Strongly Agree


  1. What (if any) gaps were you able to identify by using TEST? (open)


  1. How will you use the information you acquired from participating in the exercise/game? (open)


  1. What did you find was the most valuable aspect of the exercise/game? What was your favorite moment or aspect of the exercise/game? (open)

Measures of Improvement for Future Design

Please answer the following questions to help determine if adjustments need to be made for the implementation of this tool.


  1. In my opinion, the length of exercise/game play was

  1. Not long enough

  2. Adequate time

  3. Too long


  1. In my opinion, the level of difficulty of exercise/game play was

  1. Very Difficult

  2. A little difficult

  3. Adequate difficulty

  4. Not difficult enough


  1. I prefer to learn the rules and how to play using: (select all that apply)

  • Rule book

  • Introduction video

  • Playthrough guide (Such as a step by step walk through document)

  • Test round/walk through with facilitator


  1. What information would have been helpful before the exercise/game? (open)


  1. What materials would be helpful to you about [CRCs or Rad/Nuclear threats/PODs/Incident Command System]? (open)


Closing Comments

  1. Please provide any additional comments relating to exercise/game content or format so we may better identify areas of strength and those needing improvement. (open)


  1. Please provide any other comments of suggestions you would like to share. (open)


Optional Feedback

  1. Would you like to be contacted for additional follow-up via a focus group interview?

  1. Yes

  2. No

  1. If yes, please provide your name and business email address. Your information will only be used to follow up with you to schedule a web call. (open)


Thank you for providing your feedback, opinions, and ideas. Your input will be used to enhance trainings for future participants.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorFinklea, Lauren (CDC/DDPHSIS/CPR/DSLR)
File Modified0000-00-00
File Created2025-07-02

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