Taking the Next Step Registration Form
Whether registering as an individual or an organization, please tell us more about yourself or your group. If you are unsure or uncomfortable answering any question, please feel free to skip them. The information gathered in this registration process will be kept confidential and only used to help us evaluate the National Guidelines. If you are registering an organization, please assign one person to be the “Point of Contact.
What is your work email address? *
Please include your full work email address.
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Virgin Islands, U.S.
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Implementing the National Guidelines This section of the survey asks about your workplace’s efforts to implement the National Guidelines. How committed is your workplace to implementing suicide prevention programming? Please rate the importance of each tactic for your workplace. Trainings (i.e., management training, awareness training) Resources (i.e., EAP, contact for local or industry specific mental health services, peer support) Tools (i.e., self-screening, educational materials) Workplace Demographics
Please take a few moments to respond to the following demographic questions. The purpose of this section is to help us make sure our survey is reaching a representative sample of viewpoints.
Your workplace belongs to which of the following industries? These categories come from the North American Industry Classification System. How large is your workplace? Workplace Culture & Suicide Prevention, Intervention and Crisis Response The following questions focus on your company or organization’s culture regarding suicide prevention.
Choose the options that best reflects the extent to which these statements are true for your workplace.
Our wellness and safety programs include mental health literacy, emotional resilience and suicide conversation skills training. Leadership and management understand the link between physical and mental health and promote an integrated approach to employee wellness. Leadership reassures those who are experiencing mental health challenges or overwhelming life experiences and demonstrates that they “have their back”. Leadership is aware of psychosocial hazards at work and seeks to reduce job strain and toxicity. Implementing the National Guidelines The following questions ask about your workplace’s efforts to implement the National Guidelines.
To what extent has your organization prioritized the following nine practices from the National Guidelines. Please rate the priority level for each practice at your workplace.
Bold leadership that cultivates a caring culture focused on community well-being Communication that increases awareness of understanding suicide and reduces fear Employee self-care through screening and stress/crisis inoculation planning Training that builds a stratified suicide prevention response program specialized by workplace role Peer support and well-being ambassadors Mental health and crisis resources that are vetted and promoted Risk mitigation that addresses access to lethal means and legal issues Crisis response that includes accommodation, re-integration, and postvention Briefly, how has your workplace begun to implement the National Guidelines? How confident are you that your workplace can adopt and utilize the National Guidelines? What barriers, if any, exist for your workplace implementing suicide prevention strategies? (Choose all that apply) What method(s) would work best to spread awareness of mental health issues or suicide prevention strategies in your workplace? (Choose all that apply) Experience with Suicide at Your Workplace This section asks about suicide experiences in your workplace. Please answer to the best of your knowledge. Has someone in your workplace experienced a suicide death in the last 12 months? What is your workplace’s connection(s) to suicide death(s) in the last 12 months? (Choose all that apply) Has someone in your workplace experienced a suicide death in the last 10 years? What is your workplace’s connection(s) to suicide death(s) in the last 10 years? (Choose all that apply) Knowledge About Suicide Prevention These questions ask about your knowledge regarding suicide experiences resources and strategies. Do you know how to access the National Suicide Prevention Lifeline? Do you know how to access the Crisis Text Line? Are you actively promoting crisis resources? Which one(s) are you promoting? Workplace Employee Assistance Program (EAP) This section focuses on your workplace’s Employee Assistance Program (EAP). Our workplace has a known and accessible EAP that has been vetted as a quality benefit. How many times per year does your workplace promote the EAP? How does your workplace promote the EAP? (Choose all that apply) Final Thoughts This final question focuses on any other information that you would like to share about suicide prevention in your workplace. Do you have any other thoughts about the National Guidelines/suicide prevention strategies in your workplace that were not covered by the above questions? Thank You
Thank you for taking the time to register to be a pledge partner of the National Guidelines. Now let's get started.
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