PSM QUESTIONNAIRE — NYPD HEALTH AND WELLNESS SECTION

PEER SUPPORT PROGRAM QUESTIONNAIRE

Please complete the form below and answer the following questions in order to help us determine your eligibility for this very important role. All fields are required.

Name

First Name

Last Name

NYPD Email

Tax#

Phone

(###)

###

####

Command

Name, not code

1) Tell us how you take care of your own well-being and what supports you have in place.

2) What makes you a strong candidate for the peer program? What unique experiences or strengths would you bring to this role?

3) How comfortable are you approaching someone who you know, or have heard, is going through a hard time?

4) Since Peer Support Members sometimes act as liaisons between H+W Section and the command, are you comfortable speaking to a group or at roll call to make members of the command aware of various services and resources?

5) Confidentiality is an important part of the peer role. How would you respond if the Commanding Officer or another supervisor asked you what you've discussed with another member in your role as a peer support member?

6) While in the peer role you may encounter situations that are stressful and demanding. Some situations are serious and could make you uncomfortable. How would you handle these types of situations when, and if they occur?

PEER SUPPORT PROGRAM QUESTIONNAIRE

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