1.	Which best describes your department?*
	Urban Suburban Rural Frontier Other, please specify

2.	How many personnel are in your department?*
	Under 30 30-59 60-99 100-399 400 or more

3.	Does your agency also provide fire protection?*
	Yes No

4.	Does your agency provide rescue? If so, what kind?* (Select all that apply)
	No.    Yes, backcountry.    Yes, whitewater.    Yes, high-angle.    Yes, extrication.    Yes, HazMat.    Yes, other.

5.	Which of the following items do you use regularly? (Select all that apply)
	Gloves Goggles Safety Boots NFPA Certified Boots Rescue Gear Helmet Outerwear/NFPA Certified Outerwear ANSI Compliant Reflective Vest Other, please specify

6.	Which part or parts of your PPE or rescue gear needs to be replaced/refurbished most often?*

7.	Do you own a separate pair of extrication gloves?*
	No. Yes. What brand?

8.	Do you own a personal pair of station/duty boots?*
	No. Yes. What brand?

9.	At your department, is each individual issued a properly-sized N95 Mask?*
	Yes No

10.	At your department, is each individual issued (or do they have access to) an ANSI Compliant Reflective Vest?*
	Yes No

11.	At your department, do you have access to full medical PPE? (IE. Gown, face shield, etc.)*
	Yes No

12.	Does your department have a safety police in place regarding PPE?*
	Yes No

13.	Have you ever had a major problem with your PPE or rescue gear?*
	No Yes, please explain:

14.	Concerning the purchase of PPE for your department, how would you describe your role?*
	Primary Decision Maker Member of the Decision Making Team Evalute, Test, or Develop Specifications Recommend Products Purchase for Myself Not Involved

15.	How do you research your PPE/rescue gear purchases?
	Buyer's Guides    Magazines    Peer Recommendations    Personal Experiences    Web sites    Other, please specify

16.	Are you interested in more information about any of the following? (Select all that apply)
	Gloves Goggles Safety Boots NFPA Certified Boots Rescue Gear Helmet Outerwear/NFPA Certified Outerwear ANSI Compliant Reflective Vest Other, please specify

17.	Please provide your email address below to receive information from manufacturers regarding your selections above. (Optional)