Emergency Responder -- Program Evaluation / Awareness Survey

* 1. Company

* 2. Address1

* 3. Address2

* 4. City

* 5. State

* 6. Zip

* 7. First Name

* 8. Last Name

* 9. Title

* 10. Phone

* 11. Fax

* 12. Date

* 13. Email

* 14. NIOFRS#

* 15. ORI#

Program Evaluation

* 16. If you want a specific pipeline or gas company representative to contact you for further information please list company(s) below:

* 17. Please indicate specific information you would like from the company(s) listed:

* 18. Have you ever attended a program like this before?

* 19. Overall, was today's program effective?

* 20. Would you recommend this training program to others?

* 21. What is the preferred method for your agency / company to receive invitations?

* 22. What is the preferred format for your agency / company to receive future safety information materials?

Awareness Survey
The purpose of this survey is to measure public awareness regarding the location of oil and gas pipelines that crisscross our country as well as awareness regarding the safety precautions necessary for the safe delivery of those products being transported. As an active participant in public safety and emergency response activities, please take a moment to answer a few questions regarding your operations and experience regarding pipeline safety awareness.

* 23. Which of the following best describes your locale?

* 24. Are you employed by or volunteer for any of the following?

* 25. Which best describes your role regarding your organization's emergency response procedures? (Select all that apply)

* 26. Are you aware of any natural gas or petroleum pipelines running through the community you serve?

* 27. Do you know the name of the Pipeline Operators that have pipelines running through your community?

* 28. If YES, please provide the names of the operators in your area:

* 29. Do you know how to contact the local gas company or pipeline company in the event of a petroleum or gas related incident?

* 30. Do you know how to contact the local gas company or pipeline company when you need more information?