Minnesota Infragard & ISAC - Member Survey

The Infragard Minnesota Membership Alliance is working to create protocols and procedures to coordinate emergency response activities with Minnesota Homeland Security and Emergency Management. For this effort to be effective, we need your help, take a few minutes to tell us more about you and let us what you need from it. Note - individual results will remain private and not be released.
1
Your Sector - Choose the one that best represents the primary business of your company.
2
Your Profession - Describe your profession or role within your company.
3
Your Response Role within Your Company - Please describe your emergency response role within your company. Key here is your role in response, not every day. If you can be a single point of contact, accessing all company decisions and resources as necessary, select "Key Contact".
Key Contact-make/facilitate decisions/resources
Functional Contact-Response role, no decisions
Planner-Planning, not response role
Non-Responder-Interested, not planner/responder
Other, please specify
4
Your Experience/Training for Emergency Operations Center (EOC) Role - In order to determine our ability to interact operationally with emergency management activities, we need to understand the experience and availability of members. This question addresses experience and training.
Have Worked in EOC Evironment - Qualifications current
Experience in Corporate Crisis Management or EOC Environment
Currently First Responder - EMS, Police, Fire, etc.
Completed FEMA - IS-700 NIMS: An Introduction
Completed FEMA - IS-800 NRP: An Introduction
Completed FEMA - ICS-100 Introduction to ICS
Completed FEMA - ICS-200 Basic ICS
Community Emergency Response Team (CERT)
First Aid Certification
CPR Certification
Other, please specify
5
Special Skills List any additional special skills that may be useful during an emergency.
Skill 1:
Skill 2:
Skill 3:
Skill 4:
Skill 5:
6
Your availability to act in a response role during emergency?
7
Your concerns - Please check the following potential emergency response-related Infragard activities that are important to you.
Response coordination (i.e. working with State Emergency Operations Center)
Pandemic preparedness
Terrorism threat
Public and private response coordination
An exercise (such as Operation Reality Check)
2008 Republican Convention
Other, please specify
8
Your Emergency Contact Info Required to participate in Public/Private Community Action Team and receive emergency communications from State Emergency Operations.
First Name:
Last Name:
Position:
Company:
Work email:
Home email:
SMS or Text Message (5555551212@cellprovider-textname.com):
Work Phone:
Cell Phone:
Home Phone:
Pager:
Satellite Phone:
Other Phone:
Work Address:
Work City:
Work State:
Work Zip:
Home Zip:
9
What is your availability to work on planning projects?
10
Additional comments - Topics you would like to hear about, additional comments on questions above, etc.
To apply for secure Infragard Membership: STEP #1 – Review the ByLawsof the InfraGard Program STEP #2– Click on the link below and follow the instructions for the Membership Application http://www.infragard.net/membership/ STEP #3– Mail your ORIGINAL , COMPLETED Application to: InfraGard Program Coordinator Suite 1100 111 Washington Avenue, South Minneapolis, Minnesota 55401-2176 (612) 376-3200  Questions?