1. Please enter your name (Your
name is only needed in case there are technical problems and we need to
follow up with you; it will be deleted before any reporting is done.)
Please tell us more about your work in Public Health
2. Please indicate if you work for the state or for a local jurisdiction (or both).
Washington State Department of Health Local Health Jurisdiction State Board of Health Local government entity providing Human Services Other local governmental entity providing Environmental Health Services
If local health staff only, go to 2b
2a. DOH
or State Board of Health staff, please specify your primary location(s). (Check all that apply)
Kent - Center Point
Tumwater - Point Plaza East
Olympia - East Side Plaza
Tumwater - New Market Campus
Olympia - Firgrove
Tumwater - Warehouse
Shoreline - Public Health Lab
Yakima
Spokane - Freeway Plaza
Other state location (please specify)
2b. Local Health Jurisdiction or other local government staff, please specify your primary county location(s) (check all that apply):
Adams
Garfield
Lincoln
Spokane
Asotin
Grant
Mason
Tacoma Pierce
Benton Franklin
Grays Harbor
Okanogan
Thurston
Chelan Douglas
Island
Pacific
Wahkiakum
Clallam
Jefferson
San Juan
Walla Walla
Clark
Kitsap
Seattle King
Whatcom
Columbia
Kittitas
Skagit
Whitman
Cowlitz
Klickitat
Skamania
Yakima
Ferry
Pend Oreille Stevens
Lewis
Snohomish
Other local location (please specify)
If local health or local government staff only, go to Question 4
3. DOH or Board of Health Staff, please identify the Public Health program(s) in which you work (check all that apply)
OS - Office of the Secretary
EHSPHL - Office of the Assistant Secretary
OS - Communications
EHSPHL - Center for Health Statistics
OS - Policy, Legislative, and Constituent Relations
EHSPHL - Epidemiology
OS - Public Health Emergency Preparedness
& Response
EHSPHL - Public Health Laboratories
OS - Public Health Systems Planning
& Development
EHSPHL - WEDSS
OS - Other
EHSPHL - Other
CFH - Office of the Assistant Secretary
HSQA - Office of the Assistant Secretary
CFH - Community Wellness and Prevention
HSQA - Community and Rural Health
CFH - Infectious Disease and Reproductive Health
HSQA - EMS and Trauma System
CFH - Maternal and Child Health
HSQA - Facilities and Services Licensing
CFH - Other
HSQA - Health Professions Quality Assurance
EH - Office of the Assistant Secretary
HSQA - Health Systems Quality Assurance
EH - Drinking Water
HSQA - Other
EH - Environmental Health Assessment
MSD - Financial Services
EH - Environmental Health and Safety
MSD - Human Resources
EH - Food Safety and Shellfish Programs
MSD - Information Resource Management
EH - Radiation Protection
MSD -
Risk Management
EH - Other
MSD - Other
State Board of Health
4. Please record your formal job title and whether you work full-time or part-time. If in an acting position, fill out as if permanent, and focus only on your acting job title, role and responsibilities. If you have the same job title at more than one location, just record it once. If you have more than one job title, please list each separately. (If you have more than two job titles, please only list the two that take most of your time.)
Formal Job Title
Full Time
Part Time (estimated number of hours per week)
Job 1. Please specify (as used on a business card or job
classification)
If you have another way
of describing your job, please specify
Job 2. Please specify
(as used on a business card or job classification)
If you have another way of describing your job, please
specify
5. How many years have you been
a. Working in your current job position? Job Position #1
Years Job Position #2 Years
b. Working for your current agency? Job Position #1 Years Job Position #2 Years
c. Working in public health? Years
d. And indicate any additional time you may have worked in the health care industry (besides public health) Years
6. How many more years do you estimate you will work in public health? (If you are currently working in Human Services, EMS or EHS treat these positions as if they are public health positions to answer this question)
Years Not Sure
7. Does your current job include routine supervisory responsibility?
Yes
No
Looking at all your work history, how many total years have you been supervising?
8. Public Health Job Function
IMPORTANT INSTRUCTIONS! Listed below are various public health job functions. Understanding that you may be responsible for one, some or all of these functions, please identify the percentage of time spent in each category. Make sure the total equals 100% -- even if you work less than full-time.
It is important that you complete this information for the functions you serve -- which may or may not be reflected in the title of your division/department. For example, you may work in "Maternal and Child Health," but your function may be Communications, in which case you would enter the percentage of your time spent in "Communications." Likewise, if you are an executive leader, we understand that your work touches all of the functional areas described below. You may either show all of your time in "Executive Leadership," or select the categories that best summarize your work.
If you hold more than one position, please complete for both "Position 1" and
"Position 2."
Click on a function below for detailed information. Click "Other" to add new
function. Click "Back to Function List" to return to the list and add data for other roles.
a. Executive
Leadership provides organizational
leadership on key policy questions, clinical and/or administrative issues.
May work with local and or state boards of health and/or serves as key
public health spokesperson.
Please select all activities performed for this function
Position 1
Position 2
Facilitating organizational strategic planning
Providing leadership to determine organizational mission, vision and values and policy development
Developing organizational messages and/or serving as
a key public health spokesperson regarding public health issues
Providing organizational leadership on key clinical issues and direction including determining the need for and developing protocols
Other
(please describe)
(please describe)
b. Policy Analysis and Development
provides analysis, interpretation and communication regarding policy choices and/or laws and regulations or serves in liaison role between state/local health
Please select all activities performed for this function
Position 1
Position 2
Analyzing, evaluating and communicating public policy choices
Interpreting and applying laws and regulations that pertain to public health authority and responsibility
Providing liaison activities between state and local health
Other
(please describe)
(please describe)
c. Administrative/Support Services
provides financial planning and/or management/administrative support services for the organization and may include contracts, risk management, and or accounting as well as customer support services, handling meeting logistics
or medical records, staffing the front desk etc.
Please select all activities performed for this function
Position 1
Position 2
Providing financial and management support services such as accounting, budgets, facilities, liability issues and risk management,
grant writing
Providing administrative support such as handling customer service requests, creating document formats, managing logistics for meetings, providing basic information and referral, staffing the front desk, completing forms for purchasing, travel etc.
Other
(please describe)
(please describe)
d. Information and Technology Systems
provides technology system development, and/or ongoing support, and/or maintenance
Please select all activities performed for this function
Position 1
Position 2
Implementing data collection processes that ensure technology transmission compatibility and systems storage
Developing policies, procedures and technology systems that are available, reliable, appropriate, confidential, secure and supported
Developing or making decisions to purchase technology tools in user friendly formats
Providing "help desk" functions for users of information systems
Developing systems, policies and procedures for protection of confidentiality and secure data exchange and/or transfer
Consulting with users on appropriate technology standards
Applying informatics to public health
Other
(please describe)
(please describe)
e. Communication
provides internal and external development/implementation of public
information strategies and materials. May include media relations and/or risk communication
Please select all activities performed for this function
Position 1
Position 2
Providing public information dissemination to diverse entities including the public, legislators, Local Boards of Health, the media
Interacting with the
media and the public with regard to public health topics
Balancing legal and confidentiality issues for the benefit of the public
Writing guidelines for internal and external communication
Writing new releases, fact sheets, newsletter articles, marketing materials, etc.
Other
(please describe)
(please describe)
f. Workforce Development, Performance Management and Training
provides human resource development and support, training and development and/or quality improvement
i. Environmental Health
provides development of public policy, regulation, and guidelines, and provision of health information and education to the public, health care providers, and governmental agencies regarding environmental health issues and concerns
Please select all activities performed for this function
Position 1
Position 2
Providing environmental health education
Involving the community and/or stakeholders
in setting environmental health priorities
Planning for or responding to environmental events or natural disasters that threaten the public's health
Conducting risk communication
activities
Conducting emergency preparedness
activities
Tracking, recording or reporting environmental health risks and illnesses
Enforcing compliance with environmental health regulations
Other
(please describe)
(please describe)
j. Community and Family Health Promotion and Prevention
provides prevention, education and early intervention for public health programs such as MCH, Injury Prevention, STD, WIC/Nutrition, Immunizations, Health Promotion, Tobacco, Reproductive Health, Drug/Alcohol Prevention
Please select all activities performed for this function
Position 1
Position 2
Selecting public health priorities that reflect scientifically based public health literature
Obtaining active involvement of community members in addressing prevention priorities
Engaging in and supporting collaborative partnerships for dissemination of information
Providing prevention, early intervention and outreach services that are provided directly or through contracts
Providing clinical consultation
Health education
Other
(please describe)
(please describe)
k. Clinical
provides one or more clinical health care services such as physician/medical, social work, nursing, nutrition, substance abuse treatment etc. in a clinical setting and/or home visit basis
Please select all activities performed for this function
Position 1
Position 2
Providing one or more health care services (physician,
social work, mental health, nursing, nutrition, physical therapy, primary
care, case management, substance abuse treatment, etc.) in a clinical
setting or home visit basis
Other
(please describe)
(please describe)
l. Licensing and Credentialing
provides professional and/or facilitates licensing, certification or registration. May track health care shortages and/or provide support for professional boards/commissions
Providing staffing support for professional boards and/or commissions
Other
(please describe)
(please describe)
m. EMS/Trauma
provides and coordinates out-of-hospital emergency medical response and care to acute illness and trauma patients. May also regulate out-of hospital care and EMS/trauma care provided by designated trauma services.
Please select all activities performed for this function
Position 1
Position 2
Providing testing or screening of specimens to determine disease and/or toxins including newborn screening, presence of food borne disease agents, chemical agents, etc.
Providing consultation regarding specimen collection and handling and investigation
Other
(please describe)
(please describe)
o. Human Services
social services provided by those local health jurisdictions that have combined
organizational structures (e.g.
Chemical Dependency Prevention and/or Treatment Services, Developmental Disabilities and/or Mental Health)
Please select all activities performed for this function
Position 1
Position 2
Providing chemical
dependency prevention and/or treatment services: assessment, outpatient
services; detoxification, alcohol/drug involuntary commitment; ADATSA; programs
that reduce the potential use of drugs and alcohol to high-risk youth
Providing
employment/community access services for adult citizens with developmental
disabilities: collaborating with community partners to identify training and
information needs, implementing training activities, disseminating community
information, assessment of community needs, identifying resources, allocating
funding
Providing mental
health services: outpatient, inpatient and crisis mental health services; case
management, therapy, medication evaluation and management, pre-vocational
services, assistance with daily living skills; Regional Support Network
functions to ensure access to mental health services to all eligible Medicaid
recipients in the region
Other
(please describe)
(please describe)
p. Facilities Maintenance provides maintenance of facilities and grounds
Please
describe the activities performed for this function
Position 1
Position 2
Other
Education
9. Please tell us about your education by completing the table below. Indicate each level of education you have completed, the field of study and the degree held. Then make a check mark by each level of education that is required for your job.
Educational
Background
Type of Degree(s) (for each level)
Field(s) of Study
Check if this is a job requirement
a. Some high school, high school diploma or GED
b. Associate/junior college degree or diploma (e.g. A.A., Associate degree or diploma in
nursing)
c. Bachelors degree (e.g. BS, BA, BSN)
d. Masters degree (e.g. MS, MA, MPH, MHA, MSW, MSN)
e. Doctoral degree (e.g. PhD, DrPH, EdD)
f. Professional degree (e.g. MD, DDS, DO, JD, DVM)
g. Certificate in public health
h. Certified Public Accountant (CPA)
i. Certified Financial Planner (CFP)
j. Other Degrees
(please list)
10. Please tell us about other professional credentials or licenses you possess, by completing the following table. Check each credential or license you have currently.
Current
Credential
Check if this is a job
requirement
Licensed Professions
Advance Registered Nurse Practitioner
Dental Hygienist
Dentist
Licensed Practical Nurse
Marriage & Family Therapist
Massage
Mental Health Counselor
Midwife
Occupational Therapist
Osteopathic Physician and Surgeon
Osteopathic Physician Assistant
Pharmacist
Physical Therapist
Physician - Please indicate if you are Board Certified
Yes
No
If Board Certified, then list specialties
Physician Assistant
Psychologist
Registered Nurse
Social Worker
Veterinarian
Current
Certified Professions
Mark box if this is a job
requirement
Chemical Dependency Professional
Dietitian
EMS Provider
Health Care Assistant
Nursing Assistant
Nutritionist
Pharmacy Technician
Radiological Technician
Sex Offender Treatment Provider
Current
Registered Professions
Mark box if this is a job
requirement
Counselor
Nursing Technician
Nursing Assistant
Pharmacy Assistant
Recreational Therapist
X-Ray Technician
Please list any other License or Credential
Please tell us about yourself
Optional questions for demographic use only
11. Gender
Male
Female
12. Are you Spanish/Hispanic/Latino? Mark the “No” box if not Spanish/Hispanic/Latino.
No, not Spanish/Hispanic/Latino
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, Other Spanish/Hispanic/Latino (Specify)
13. What is your race? Check one or more races to indicate what you consider yourself to be
White
Black or African American
American Indian or Alaska Native - Print name of enrolled or principal
tribe
Spanish/Hispanic/Latino (see
question 12 above)
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Asian – Print race
Other Pacific Islander – Print race
Other race – Print race
14. Are you a person of disability, such that you require reasonable accommodations to perform the essential functions of your position duties and responsibilities
Yes
No
15. Are you multilingual?
Yes
No - If No, go to Question 17
Please indicate the language(s) (including American Sign language)
American Sign Language
Korean
Tagalog
English
Laotian
Tigrignia
Amharic
Russian
Vietnamese
Cambodian
Somali
Chinese
Spanish
Other (please specify)
16. Have you been certified in any language as an interpreter or translator?
Yes
No
Please indicate the language(s) (including American Sign language)
24 years or below
25-34
35-44
45-54
55 years or above
18. Please indicate the annual salary range of your current position
(This information will not be linked to you specifically, but will be used to show ranges of salaries for public health employees.
If you are a part time employee, estimate your actual salary range for the
estimated hours you work)
