Online Survey Questionnaire (to be amended as appropriate following review of KII responses)

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Online Survey Questionnaire (to be amended as appropriate following review of KII responses)

Intended Audience:
State Public Health Emergency Preparedness Directors (PHEP), with inputs from State Animal Health Officials (SAHO), State Public Health Veterinarians (SPHV) and other relevant staff
Definitions:
STLT: State, Tribal, Local and Territorial health departments 
PPE: personal protective equipment 
SNS: Strategic National Stockpile


Survey Question
Response Options
    1. Please select your jurisdiction from the list below.

    • Region 1 (CT, ME, MA, NH, RI, VT)
    • Region 2 (NJ, NY, Puerto Rico, US Virgin Islands)
    • Region 3 (DE, Washington DC, MD, PA, VA, WV) 
    • Region 4 (AL, FL, GA, KT, MS, NC, SC, TN) 
    • Region 5 (IL, IN, MI, MN, OH, WI) 
    • Region 6 (AR, LA, NM, OK, TX) 
    • Region 7 (IA, KS, MO, NE) 
    • Region 8 (CO, MT, ND, SD, UT, WY) 
    • Region 9 (AZ, CA, HI, NV USAPI*) 
    • Region 10 (AK, ID, OR, WA)


    2. Did your jurisdiction have any confirmed cases of either human or animal cases of H5N1 at the time of the one-time PPE distribution activity on May 6, 2024? 
    • Yes, both human and animal confirmed cases
    • Yes, human confirmed cases
    • Yes, animal confirmed cases
    • No, neither human or animal confirmed cases
    • I don’t know
    3. Please select your role (select all that apply if completed by more than one person): 
    • PHEP Director or co-Director
    • State Epidemiologist
    • State Animal Health Official (SAHO)
    • State Public Health Veterinarian (SPHV)
    • Other (please specify) ________________

    4. Prior to the one-time personal protective equipment (PPE) ask made by CDC on May 6, 2024 (between April 1, 2024 to May 6, 2024), did your jurisdiction receive any requests for PPE from dairy farms, poultry farms, slaughterhouse workers, farmworker organizations, agricultural businesses, or related service organizations in the state that were impacted or could be potentially impacted by Avian Influenza A(H5N1)?

    • Yes
    • No 
    • I don’t know
    5. Prior to the one-time PPE ask made by CDC on May 6, 2024 (between April 1, 2024 to May 6, 2024), did your jurisdiction proactively offer PPE to dairy farms, poultry farms, slaughterhouse workers, farmworker organizations, agricultural businesses, or related service organizations in the state that were impacted or could be potentially impacted by Avian Influenza A(H5N1)?

    • Yes
    • No 
    • I don’t know
    6. After the one-time PPE ask made by CDC on May 6, 2024 (between May 7 to August 31, 2024), did your jurisdiction receive any requests for PPE from dairy farms, poultry farms, slaughterhouse workers, farmworker organizations, agricultural businesses, or related service organizations in the state impacted or potentially impacted by Avian Influenza A(H5N1)?

    • Yes
    • No 
    • I don’t know
6a. If YES to receiving a request for PPE (question 6a), what type of entities made requests (select all that apply)? 
    • Local health departments or local health entities
    • Farms with known positives or presumptive positive dairy herds with Avian Influenza A(H5N1)
    • Farms with known positive or presumptive positive poultry with Avian Influenza A(H5N1)
    • Farms with no evidence of positive dairy herds or pending any test results
    • Farms with no evidence of positive poultry or pending test results
    • Other farm industry partners (please specify) ______ 
    • Non-farm related industry partner 
(please specify) ______
    • Slaughterhouse workers
    • Other agricultural workers (please specify) ______
    • Unknown


    7. After the one-time PPE ask made by CDC on May 6, 2024 (May 7 to August 31, 2024), did your jurisdiction proactively offer PPE to dairy farms, poultry farms, slaughterhouse workers, farmworker organizations, agricultural businesses, or related service organizations in the state that were impacted or could be potentially impacted by Avian Influenza A(H5N1)?

    • Yes
    • No 
    • I don’t know
    8. Was there a shortage of PPE during the month of May 2024 in your jurisdiction?
    • Yes
    • No
    • Do not know
8a. If YES to shortage of PPE (question 8), which supplies were temporarily unavailable or in limited supply (select all that apply)? 
    • Fluid-resistant coveralls1
    • Waterproof apron
    • NIOSH Approved® particulate respirator N95 or higher* 
    • Unvented or indirectly vented safety goggles2
    • Face shields­­
    • Head cover or hair cover
    • Gloves3
    • Boots 
    • Other (please specify) _____________
    • Unknown

* N95® and NIOSH Approved® are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

1 Preferably, fluid-resistant coveralls should be made of material that passes: AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H2O or EN 20811 ≥ 50 cm H2O; or ASTM F1670 (13.8 kPa); or ISO 16603 ≥ 3.5 kPA

2 Preferably, safety goggles should conform to ANSI Z87.1 that is marked at least Z87 D3

3 Preferably, gloves should conform to ASTM D3578 (latex rubber examination gloves), ASTM D5250 (vinyl examination gloves), ASTM D6319 (nitrile rubber examination gloves), or ASTM D6977 (chloroprene ­­examination gloves). If thicker gloves are required, rubber gloves should be waterproof and exclude linings. If latex allergies are present, avoid latex. These gloves could be worn underneath the exterior principal glove (e.g., gloves for cold protection, manual shoveling) for protection against direct skin exposure if the outer glove is physically compromised.


    9. Do you have a stockpile of PPE in your jurisdiction (select all that apply)?
    • Yes, at least some local health departments have a stockpile
    • Yes, all local health departments have a stockpile
    • Yes, state health department has a stockpile
    • Yes, both local health departments and state health departments have a stockpile
    • Yes, tribal health departments have a stockpile
    • Yes, both tribal health departments and state health departments have a stockpile
    • Yes, all (state, tribal, local) health departments have a stockpile
    • No, no stockpiles of PPE exist in my jurisdiction
    • Unknown
    • Other _____________
9a. If YES to stockpile(s) of PPE (question 9), which types of PPE are in stockpile(s) (select all that apply) in total? 
    • Fluid-resistant coveralls
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Waterproof apron
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • NIOSH Approved® particulate respirator N95 or higher* 
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Unvented or indirectly vented safety goggles
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Face shields­­
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Head cover or hair cover
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Gloves 
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Boots 
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Other (please specify) _____________
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile
    • Unknown
        ◦ In local health department stockpile
        ◦ In state health department stockpile
        ◦ In tribal health department stockpile

* N95® and NIOSH Approved® are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

1 Preferably, fluid-resistant coveralls should be made of material that passes: AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H2O or EN 20811 ≥ 50 cm H2O; or ASTM F1670 (13.8 kPa); or ISO 16603 ≥ 3.5 kPA

2 Preferably, safety goggles should conform to ANSI Z87.1 that is marked at least Z87 D3

3 Preferably, gloves should conform to ASTM D3578 (latex rubber examination gloves), ASTM D5250 (vinyl examination gloves), ASTM D6319 (nitrile rubber examination gloves), or ASTM D6977 (chloroprene ­­examination gloves). If thicker gloves are required, rubber gloves should be waterproof and exclude linings. If latex allergies are present, avoid latex. These gloves could be worn underneath the exterior principal glove (e.g., gloves for cold protection, manual shoveling) for protection against direct skin exposure if the outer glove is physically compromised.

9b. If YES to a stockpile of PPE (question 9a), has PPE been deployed from the STLT stockpile? 
    • Yes
    • No
    • Unknown

    10. Was PPE requested from the Strategic National Stockpile (SNS)? 
    • Yes
    • No, no PPE was requested
    • Unknown

    11. Are there plans to request PPE from the SNS?
    • Yes
    • No
    • Unknown

    12. What type of PPE was requested on behalf of the end user from the one-time distribution of PPE request? Please select all that apply. (Make this a skip order logic if more than one organization requested)





    • Fluid-resistant coveralls
    • Waterproof apron
    • NIOSH Approved® particulate respirator N95 or higher* 
    • Unvented or indirectly vented safety goggles
    • Face shields­­
    • Head cover or hair cover
    • Gloves 
    • Boots 
    • Other (please specify) _____________
    • Unknown

* N95® and NIOSH Approved® are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

1 Preferably, fluid-resistant coveralls should be made of material that passes: AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H2O or EN 20811 ≥ 50 cm H2O; or ASTM F1670 (13.8 kPa); or ISO 16603 ≥ 3.5 kPA
2 Preferably, safety goggles should conform to ANSI Z87.1 that is marked at least Z87 D3
3 Preferably, gloves should conform to ASTM D3578 (latex rubber examination gloves), ASTM D5250 (vinyl examination gloves), ASTM D6319 (nitrile rubber examination gloves), or ASTM D6977 (chloroprene ­­examination gloves). If thicker gloves are required, rubber gloves should be waterproof and exclude linings. If latex allergies are present, avoid latex. These gloves could be worn underneath the exterior principal glove (e.g., gloves for cold protection, manual shoveling) for protection against direct skin exposure if the outer glove is physically compromised.

    13. Who were the key messengers to offer PPE to dairy farms, poultry farms, slaughterhouse workers, farmworker organizations, agricultural businesses, or related service organizations in the state? (e.g., state veterinarians, extension workers, community leaders, etc.) Select all that apply. 



    • State Veterinarians 
    • State Public Health Veterinarians
    • Local Veterinarians (or other veterinarians) 
    • Agriculture extension workers
    • Community leaders 
    • Religious leaders
    • Others (please specify) _________
    • Not applicable


    14. Which options best describes the pathway or method of distributing PPE to dairy farms, poultry farms, slaughterhouse workers, farmworker organizations, agricultural businesses, or related service organizations in the state if applicable? Select all that apply.



    • Directly to farms/agricultural organizations (either dairy, poultry, or slaughterhouse) from state health department 
    • Directly to farm/agricultural organization employers (either dairy, poultry, or slaughterhouse) from local health department 
    • Directly to farm/agricultural organization employers (either dairy, poultry, or slaughterhouse) from a tribal health department
    • Directly to farms/agricultural organizations employers from state agricultural associations (e.g., state dairy associations)
    • Directly to farms/agricultural organizations from university extension agents
    • Other (please specify) ______________
    • Unknown

    15. Did you experience or observe any barriers related to PPE distribution? Select all that apply.
    • Workers were not interested in using PPE 
    • Operators were not interested in promoting the use of PPE 
    • Workers did not understand the risks of avian Influenza A(H5N1) infection
    • Operators did not understand the risks of avian Influenza A(H5N1) infection
    • Workers felt they were at a low risk of acquiring avian Influenza A(H5N1) given the nature of their job (e.g., did not work directly with milking cows)  
    • Operators felt workers were at a low risk of acquiring avian Influenza A(H5N1) given the nature of the workers’ job (e.g., did not work directly with milking cows)  
    • Issues or concerns with managing the heat/extreme temperatures and having to use PPE  
    • Respirator fit testing not available/not used 
    • Language barrier impeded messaging  
    • Workers’ lack of access to technology (ex: cell phones or computers) to receive messaging 
    • Workers not using social media where messages were shared
    • Fear about legal status in the country 
    • Unknown 
    • Other ________________ If so, please explain.

    16. Among the barriers listed above, which did you perceive to be the greatest barriers or most challenging to overcome? Select your top three.
    • Workers were not interested in using PPE 
    • Operators were not interested in promoting the use of PPE 
    • Workers did not understand the risks of avian Influenza A(H5N1) infection
    • Operators did not understand the risks of avian Influenza A(H5N1) infection
    • Workers felt they were at a low risk of acquiring avian Influenza A(H5N1) given the nature of their job (e.g., did not work directly with milking cows)  
    • Operators felt workers were at a low risk of acquiring avian Influenza A(H5N1) given the nature of the workers’ job (e.g., did not work directly with milking cows)  
    • Issues or concerns with managing the heat/extreme temperatures and having to use PPE  
    • Respirator fit testing not available/not used 
    • Language barrier impeded messaging  
    • Workers’ lack of access to technology (ex: cell phones or computers) to receive messaging 
    • Workers not using social media where messages were shared 
    • Fear about legal status in the country 
    • Unknown 
    • Other ________________ If so, please explain.

    17. Did health departments promote PPE usage in response to requesting or receiving the one-time PPE distribution? (For example, this could be promotion via flyers or via social media)

    • Yes
If yes, then please explain: __________________
    • No
    • Do not know


    18. Did agricultural partners promote PPE usage in response to requesting or receiving the one-time PPE distribution? (For example, this could be promotion via flyers or via social media)
    • Yes
If yes, then please explain: __________________
    • No
    • Do not know


    19. Did dairy farm promote PPE usage in response to requesting or receiving the one-time PPE distribution? (For example, this could be promotion via flyers or via social media)
    • Yes
If yes, then please explain: __________________
    • No
    • Do not know


    20. Did poultry farm promote PPE usage in response to requesting or receiving the one-time PPE distribution? (For example, this could be promotion via flyers or via social media)
    • Yes
If yes, then please explain: __________________
    • No
    • Do not know


    21. Did slaughterhouse operators promote PPE usage in response to requesting or receiving the one-time PPE distribution? (For example, this could be promotion via flyers or via social media)
    • Yes
If yes, then please explain: __________________
    • No
    • Do not know


    22. How beneficial was CDC’s recommendation to offer a one-time distribution of PPE to protect farmworkers from Avian Influenza A(H5N1)? Please select one option and explain your reasoning. 
    • 4- Very Beneficial
Explain _________________
    • 3- Somewhat beneficial
Explain _________________
    • 2- Neutral
Explain _________________
    • 1- No benefit
Explain _________________