Demographic Questions Template
Demographic Questions
Choose the appropriate questions for your survey. Most NWCPHP surveys routinely use only a subset of these questions. Additional questions can be used in specific surveys as needed.
Which one of the following categoriesbest describes your job position or primary role?
Administrator, Manager, or Director
Bioterrorism or Chemical Terrorism Coordinator
Dental Professional
Emergency Management planner
Environmental Health professional
Epidemiologist or Biostatistician
First Responder (EMT, paramedic, firefighter)
Health Educator/Trainer
Infection Control Practitioner
Information Technology specialist
Laboratorian
Law Enforcement (police, state patrol, FBI, etc.)
Legal Professional (attorney, judicial)
Mental or Behavioral Health professional
Nurse (community or public health nurse)
Nurse (other RN, LPN, BSN, etc.)
Pharmacist
Physician
Public Information, Media Relations, or Communications specialist
Student
Teacher/Faculty
Veterinarian
Other, please specify:
In what state do you work?
Alaska
Idaho
Montana
Oregon
Washington
Wyoming
Other, please specify:
The area where I work is considered:
Urban
Rural
Both
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Demographic Questions Template
What type of organization or agency do you work for?
College or university
Community-based or nonprofit organization
Federal health agency
Health department - local/county
Health department – state
Hospital, medical center, clinic, or other health delivery center
Police, fire, or EMS
Private industry or business
Tribe or tribal organization
Other, please specify:
What is your current job function? (Mark all that apply.)
Provide services directly to the public
Supervise those who provide services to the public
Coordinate or administer one or more programs or sections
Deliver specialized or technical services
Provide administrative support
What is your race? (Select one or more):
Black or African American
Alaska Native or American Indian
Asian
Native Hawaiian or Other Pacific Islander
White
Other
Decline to State
Do you identify yourself as Spanish/Hispanic/Latino?
Yes
No
Decline to State
What is your gender?
Female
Male
Decline to State
What is your highest level of education?
High school or equivalent
Certificate or training program
Associate
Bachelors
Masters
Doctorate
Other
What is your age?
19 or under
20-29
30-39
40-49
50-59
60 or over
Decline to State
How long have you worked in the field of public health?
Less than 1 year
1 - 3 years
4 - 6 years
7 - 10 years
More than 10 years
How many years have you been at your current position?
Less than 1 year
1 - 3 years
4 - 6 years
7 - 10 years
More than 10 years
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