Preparedness for Rehabilitation Staff Deployment Questionnaire

The aim of this survey is to understand your willingness and preparedness for deployment to future disasters to assist and provide rehabilitation needs of disaster victims.
Your input and suggestions will help us to create a database of rehabilitation personnel for deployment, and capacity for training/education of rehabilitation workforce in disaster and austere settings.

Thank you for your time and contribution.

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* 1. Name

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* 2. Gender

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* 3. Age (years)

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* 4. Country

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* 5. Job title

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* 6. Organisation

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* 7. E-mail address

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* 8. Telephone (Work/ Mobile)

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* 9. Other contact details

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* 10. Any other relevant information training, education, etc.)

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* 11. Please indicate your profession

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* 12. Highest level of Education

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* 13. Years of experience

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* 14. Do you have current registration with your country’s Health Practitioner Regulation Agency?

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* 15. Where do you mostly work in?

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* 16. Do you have any experience in deployment to disaster settings?

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* 17. Are you interested in deployment to disaster setting?

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* 18. How long notice is needed for you to be deployed to future disasters?

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* 19. Did you have any training related to disaster management and preparedness?

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* 20. What kind of disaster management and preparedness training/education would you like to have?

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* 21. Do you have special medical needs or physical impairments that require consideration?

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* 22. Are your vaccinations up-to-date?

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* 23. Do you provide consent for the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) or the International Society of Physical and Rehabilitation Medicine (ISPRM) to access the information above?

Please e-mail, fax or post to:
Dr Su Yi Lee
Bld-21 Royal Park Campus, Royal Melbourne Hospital,
34-54 Poplar road,
Parkville, Victoria 3052, Australia.
Tel. +61 (03) 83872146; Fax.: +61 (03) 83872222
e-mail: SuYi.Lee@mh.org.au

Thank you for taking your time in completing this survey!
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