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7809 Southtown Center, #174 • Bloomington MN 55431
612-207-1130
info@metrocismn.org
Team Members
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EVALUATION SURVEY
Please take the time to complete this form to help us support others in the future.
First name
Last name
Email
*
Please rate The Metro CISM Team members on the following: Clearly explained the ground rules.
*
Very good
Good
Adequate
Poor
Very Poor
No response
Please rate The Metro CISM Team members on the following: Managed group discussion effectively.
*
Very good
Good
Adequate
Poor
Very Poor
No response
Please rate The Metro CISM Team members on the following: Provided enough specific information on critical incident stress reactions.
*
Very good
Good
Adequate
Poor
Very Poor
No response
Please rate The Metro CISM Team members on the following: Helped to bring to mind new or different ways of coping with stress.
*
Very good
Good
Adequate
Poor
Very Poor
No response
Please rate The Metro CISM Team members on the following: Talked enough but not too much.
*
Very good
Good
Adequate
Poor
Very Poor
No response
Talking with the team members was:
*
Easy
Slightly uncomfortable
Difficult
No response
I was able to say all that I thought/felt about the incident.
*
Yes
No
No response
By the end, I felt that this meeting was helpful in dealing with the stress of the incident.
*
Agree
Neutral
Disagree
No response
I will recommend these services to others.
*
Yes
No
No response
The following list contains common reactions often experienced after a stressful call. Please check ALL that you are currently experiencing as a result of this event.
Nausea/stomach upset
Heroic
Can't talk to others about it
Sadness
Headache
Poor concentration
Can't stop thinking about the event
Sleep disturbance
Keep remembering the event (seeing, hearing, smelling, etc)
Pumped up
Chest pain
Anxiety
Satisfied
Proud
Irritable
Anger
Diarrhea
Easily startled
Distracted
Guilt
Aching muscles
Forgetful/losing things
Bad dreams
Fast heart beat
No reaction (and it bothers me)
No reaction
No response
How stressful was this event in comparison to others in your career?
*
The most stressful
Very stressful
Somewhat stressful
Not at all stressful
No response
What did you like MOST about your experience with the Metro CISM Team today?
What did you like LEAST about your experience with the Metro CISM Team today?
How could the Metro CISM Team improve our services?
Please indicate your discipline.
*
Law Enforcement
Firefighter/EMS
Firefighter
EMS
Dispatch
No response
Other
Please indicate your length of service.
*
0-4 years
5-10 years
11-15 years
16-20 years
21-25 years
26+ years
No response
Other
Your attendance today was:
*
Voluntary
Manditory
No response
This was my first CISM debriefing:
*
Yes
No
No response
Other/Note
Submit
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