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Full Name
Title
Organization
Email Address
Phone
Address
City
State/Province
Zip/Postal Code
Country
What is your church’s average weekly attendance?	Under 1000 1500-3000 3000-5000 5000+
How prepared is your church to respond to and manage an emergency such as a fire, child abduction, or active shooter?	My church has not considered the need for plans in case of emergencies. We have discussed the need, but have not written any plans. We have basic plans, but have not trained staff. We have plans, have trained our staff, but have not tested the plans. We have plans, have trained our staff, have tested the plans, and feel we are prepared for an emergency.
What is the current level of pandemic planning at your facility?	I do not feel pandemic is a real threat to my church. We have discussed the need, but have not written any plans. We have a basic plan, but have not trained staff. We have a plan, have trained our staff, but have not tested the plan. We have a plan, have trained our staff, have tested the plan, and feel we are prepared for a pandemic.
What other services does your church offer which would need to be included in emergency planning? Select all that apply.	School Nursery or daycare Youth/teen/young adult groups Use by outside groups like Alcoholics Anonymous Gymnasium or fitness center facilities Feeding or sheltering of the needy/homeless Large/special events Residence of clergy or pastors Other
If you answered "Other" above, please describe.
Would you like more information about developing comprehensive emergency response and management plans?	Yes No