Consent: I agree to participate in this anonymous and voluntary survey. I grant permission for the data to be used for informational purposes.
□Yes	□No
1.Which of the following best describes your age?
□Less than 18 years old	□Between 61–80 years old
□Between 18–40 years old	□More than 81 years old
□Between 41–60 years old
2.Which of the following best describes your sex?
□Male	□Other __________________
□Female	□Decline to respond
3.Which of the following best describe(s) your race? (Mark all that apply):
□American Indian/Native American	□Black
□Asian or Pacific Islander	□White
□Decline to Respond
4.Which of the following best describes your ethnicity? (Select only one):
□Hispanic or Latino	□Decline to respond
□Not Hispanic or Latino
5.What is the highest grade or year of school you have completed?
□Less than high school	□Decline to respond
□More than high school
6.What is your current working status?
□Employed—part or full time	□Student
□Unemployed	□Homemaker
□Retired
7.Have you ever learned CPR (cardio-pulmonary resuscitation) before?
□Yes	□Unsure
□No
8.Have you ever learned how to administer AED (Automatic External Defibrillator) before?
□Yes	□Unsure
□No
9.Think about where you work or go to school. Do you know if there is an AED in the building?
□Yes, I am certain there is an AED and I know exactly where it’s located.
□I’m not sure if there is an AED.
□No, I am certain there is no AED.
10.In your knowledge, is cardiac arrest the same as a heart attack?
□Yes	□Unsure
□No
11.What is your primary motivation for taking this course today?
□General interest in learning
□To help a family member who might need it (child or ill)
□Work requirement
□To help/save a life in case of an emergency
□Work in healthcare or in a field with patient contact
□To teach others
□Other __________________
12.What is the approximate number of people you are planning to teach CPR and AED use after taking this course using CPR Anytime Training Kits? _________________________________________
13.In your opinion and experience, what are the main concerns people in the community might have about performing CPR? (Mark all that apply)
□Afraid to be sued if the person dies
□Being wrongfully accused of sexual harassment
□Catching a disease (e.g., during mouth-to-mouth breathing)
□Afraid of harming the person
□Hurting myself while I am doing CPR
□Somebody else would do it better
□Performing CPR incorrectly due to insufficient training
□Other (explain): __________________
14.In your opinion and experience, which of the following factors might influence willingness to perform CPR on someone? (Mark all that apply)
□Knowing the person, in any capacity other than family
□Whether they are a family member or not
□Whether someone is a medical professional or not
□Age of the person in cardiac arrest
□Gender of the person in cardiac arrest
□Race/ethnicity of the person in cardiac arrest
□Whether person providing CPR has a physical disability
□Other (explain): __________________
15.In your opinion and experience, what are some reasons for not using an AED on a stranger who collapses in public?
□An AED looks difficult to use.
□I do not think that I am allowed to use an AED.
□An AED will not help the person.
□I am afraid that an AED will harm the person.
□I don’t know how to use an AED.