Online Survey Software | Qualtrics Survey Solutions

Name:

Agency Name

E-mail:

Please describe your knowledge about:

Please describe your knowledge about:
	Low	Medium	High
Facts concerning suicide prevention:	Low	Medium	High
Warning signs of suicide	Low	Medium	High
How to ask someone about suicide	Low	Medium	High
Persuading someone to get help	Low	Medium	High
How to get help for someone	Low	Medium	High
Information about local resources for help suicide	Low	Medium	High

Rate your level of understanding about suicide and suicide prevention:

Rate your level of understanding about suicide and suicide prevention:
	Low	Medium	High
Click to write Statement 1	Low	Medium	High

Do you feel that asking someone about suicide is appropriate?

Do you feel that asking someone if they are thinking of suicide is helpful?