1. What is your role at hospice?* Bereavement Counselor Chaplain Social Worker Complimentary Therapy 2. How many years have you worked in hospice?* 0-3 years 4-7 years 8-15 years 16 or more years 3. Have you had any crisis response training?* Yes No 3a. What was the training?*3b. When was it?* 3c. Where did you take the training?* 4. While working in hospice have you ever responded to an incident such as a difficult or unexpected death to provide support?* Yes No 4a. Was it a death in hospice or in the community?* Hospice Community Both 4b. What was the situation and what was your role?*4c. If you have had more than one or two, please summarize your involvement in the most significant incidents.*4d. Can you think of a situation where staff could have benefitted from more intentional support after a death?5. Are you interested in a training to provide or assist in support for staff after a difficult death?* Yes No 6. Please provide your name so we know who has training and experience in which locations.* Δ
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