• Administered By:
• Trained Non-Expert
• Administration Mode:
• N/A
• Administration Time:
• N/A
• Ease of Use:
• Easy
• Language:
• English
• Number of Survey Questions :
• 1-25
• Resource Type:
• Research Protocol
• Study Population:
• General, Age
  • Age: Adult
• Event Type:
• Chemical, Contamination or Release Event, Extreme Weather-Related Event, Geologic Event, Humanitarian Event, Infectious Disease Outbreak, Large-Scale Accident, Large-Scale Violence or Terrorism, Radiation, Contamination or Release Event
  • Extreme Weather-Related Event: Drought Flood Hurricane Temperature Tornado or Wind Storm Wildfire
  • Geologic Event: Earthquake Landslide Volcanic Eruption
• Exposure Agent:
• Biological or Infectious Agent, Chemical Agent, Physical or Violence Agent, Radiological Agent
  • Biological or Infectious Agent: Allergen Bacteria Mold/Fungus Virus
    • Virus: Dengue Ebola H1N1 Influenza SARS-CoV-2, SARS-CoV-1, MERS West Nile Virus Zika Virus
  • Chemical Agent: Air Pollutant Asbestos Hormone Disruptor or Hormone Mimic Metal Mixture Nanomaterial Pesticide/Herbicide/Fungicide
    • Air Pollutant: Carbon Monoxide Ground Level Ozone Particulate Matter Polyaromatic Hydrocarbon
  • Physical or Violence Agent: Bomb or Improvised Explosive Device (IED) Debris Noise
• Health Impact or Organ System:
• Injury, Mental Health or Well-Being
• Special Topics:
• Demographics, Lifestyle or Quality of Life, Perceptions, Social Determinants of Health, Social Support or Resilience
• Funding Source:
• National Institues of Health
  • National Institues of Health Grant Number: es027704
  • National Institues of Health Source Name: NIEHS SRP

Consent Form
Oral Consent Script

Documentation
Information Sheet

Sample Collection Form
PFAS Sampling
SVOC Sampling

Survey/Questionnaire
12 Item Short Form Health Survey
Buckners Index of Cohesion
Items for Index of Perceived Community Resilience
Demographics and Basic Household Information
Environmental Health Threat and Trust
2020 Behavioral Risk Factor Surveillance System Survey