Intervention Response (confidential)
Collecting this data does a couple things. First it allows teams to have a central repository for their responses for their records. Secondly, it allows us to show to prospective donors all of the great work we are providing to others.
Name of crisis team member
*
First Name
Last Name
Email of crisis team member
*
example@example.com
Crisis Response Team Name
*
Date
*
-
Month
-
Day
Year
Date
Intervention Target
*
police
fire
EMS
mixture of disciplines
medical
educational
business
other
If other, please provide target group
County of Intervention
*
Intervention Type
*
one-on-one
defusing
debriefing
post-action staff support
crisis management briefing
other
If other, please provide type of intervention
Quantity
*
Intervention Type
one-on-one
defusing
debriefing
post-action staff support
crisis management briefing
other
If other, please provide type of intervention
Quantity (if more than one)
Intervention Type
one-on-one
defusing
debriefing
post-action staff support
crisis management briefing
other
If other, please provide type of intervention
Quantity (if more than one)
Comments
Submit
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