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Illinois Firefighter Peer Support Team
Evaluation Form
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ILFFPS Evaluation Form Directions
Please provide as much information as you would like to share below.
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Age
Choose
18-25
26-34
35-44
45-54
55-64
65+
Gender
Male
Female
Clear selection
Years of Service
Choose
1-3
3-5
5-10
11-20
20+
MABAS Division
Your answer
Rank/Title
Your answer
Presenting Issue(s)
Personal
Professional
Both
Previous Services
NONE
ILFFPS
Other Peer Support
Professional Counseling/Therapy
Other:
Presenting Issue(s)
Your answer
Peer Supporter Name
Which supporter was assigned to help?
Your answer
What specific aspects of Peer Support did you find most useful to you?
Your answer
What specific aspects of peer support did you find most in need of change?
Your answer
What would you suggest should be added to peer support?
Your answer
Other Comments?
Your answer
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