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Garrett County Family Violence Coalition
Professional Awareness Team
PROVIDER SURVEY
 If you have not already
completed this survey, please PRINT this page out and mail or fax your
survey to the Garrett County State's Attorney's Office at the address above.
Results of the survey will be collated on an ongoing basis. Survey results
will be linked to this page in the near future.
The purpose of the Provider
Survey is to identify service gaps so that local providers can improve
the way that we provide services for victims of family violence while at
the same time increasing the prosecution rate for offenders. |
Name _______________________________________________________
Agency or Organization _________________________________________
Address ______________________________________________________
______________________________________________________
TELEPHONE ____________________________________
FAX ____________________________________________
E-MAIL _________________________________________
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When a victim of domestic violence presents to you, what referrals are
you aware of for him/her?
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To whom, if anyone, do you report adult victims of domestic violence?
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To whom, if anyone, do you report child victims of domestic violence?
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Please describe any established protocols you have for reporting domestic
violence acts and/or victims? (If they are written, please attach
a copy of your protocol and of any reporting form to this survey.)
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Please describe any established protocols you have for treating domestic
violence acts and/or victims? (If they are written, please attach a copy
to this survey.)
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Do you see a need for any specific resources to assist victims of domestic
violence? (If "yes", please list.)
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What expertise in identifying or treating domestic violence victims
do you have that you could share with other professionals in the community?
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Would you attend training to better identify/treat/refer victims of
domestic violence?
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What format(s) do you prefer for training? (Check all that apply.)
_____ grand rounds ______ meetings
_____ seminars ______ round tables
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What time do you prefer for training? ______ early morning ______ morning
_______ lunch hour ______ afternoon ______ evening
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Please use the reverse side of this survey to add your comments
on the Professional Awareness Team, its goals and this process.
Return to the
Garrett County State's Attorney's Page
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Back to FVC ZERO TOLERANCE Page
Garrett County State's Attorney's Office