1. Where should we send your FREE safety materials?
2. Number of employees and volunteers in your organization: 0-5 6-10 11-20 21-50 51+ Please make a selection
3. What is the nature of your organization?(Check all that apply.)
Police
Fire
EMS
Search/Rescue
Sheriff
Volunteer Fire
Combined Fire/EMS
Highway Patrol
Other (please explain):
4. How will you use these safety materials? (Check all that apply.)
Safety meeting/training
New recruit
5. What do you feel are the most important safety topics that need to be covered in training materials?
6. How much do you agree with each of the following statements?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Duke Energy is committed to the safety of first responders like me.
The information Duke Energy provides is valuable for keeping first responders safe around electricity.
I expect Duke Energy to provide first responders the information necessary to get their jobs done safely around Duke Energy’s electric infrastructure.
The first responders at my organization use the Duke Energy safety information to work more safely around electricity.
The first responder materials provided by Duke Energy help me and/or my coworkers perform their jobs more safely.
ID
BRC Code
Date (mm/dd/yy)
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