Rabies exposure assessment tool

Rabies is a fatal but preventable disease. It is important to seek help right away if you think you have been exposed to determine if you need rabies treatment.

This survey will ask you some questions to figure out your risk of exposure to rabies. Based on your responses and the determined level of risk, the survey will provide you with information on who to contact for next steps. If you prefer to speak to someone on the phone, please call your local health department.

Click here to learn more about rabies.

Do you work for a rabies response entity (health department, animal control, DWR, veterinarian, healthcare provider, etc.)?

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Yes

No, I am a member of the public

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What type of rabies response agency are you a part of, if applicable:

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If you selected other, provide your job title or field of work:

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Are you using this tool to assess an actual situation in which a rabies exposure may have occurred?

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Yes

No, I am using this tool for educational or hypothetical purposes only. My responses are not related to an actual event.

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Read the following statement to the individual you are interviewing, and select the response of the interviewee:

"I am using a survey tool that asks some questions to figure out your risk of exposure to rabies. If you provide information in this survey, this information will be used by the Utah Department of Health and Human Services and your local health department. The responses you provide in this survey will only be used to determine if a rabies exposure may have occurred, and for anonymous data analysis of rabies exposures in Utah. The information you give in this survey will be saved in a confidential and secure database. Do you consent to the use of your information as described?"

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Yes

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Now read the following statement to the individual you are interviewing:

"Providing your contact information allows us to connect you with rabies prevention services if we feel this is necessary. Rabies prevention measures can be life-saving in the event of a rabies exposure. If you complete this survey without providing your contact information, we will not be able to help connect you with rabies prevention services."

Note: DHHS will only contact the person when we feel that it is necessary to fill a gap in rabies prevention.

Your first and last name (person filling out this survey):

Name of your organization or agency:

Your phone number:

Your email address:

First and last name of person(s) involved in the possible rabies exposure (bite victim, owner of exposed pet):

Best phone number to reach person(s) involved:

Best email address to reach person(s) involved:

County of residence of person(s) involved:

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State of residence of person(s) involved:

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Country of residence of person(s) involved:

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State where possible rabies exposure occurred:

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Country where possible rabies exposure occurred:

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County where possible rabies exposure occurred:

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Provide as much detail as possible about the exposure location (city, street, building, name of trail, park, or recreation area, etc.):

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If you provide information in this survey, you consent to this information being used by the Utah Department of Health and Human Services and your local health department. The responses you provide in this survey will only be used to determine if a rabies exposure may have occurred, and for anonymous data analysis of rabies exposures in Utah. The information you give in this survey will be saved in a confidential and secure database.

Providing your contact information allows us to connect you with rabies prevention services if we feel that this is necessary. Rabies prevention measures can be life-saving in the event of a rabies exposure. If you complete this survey without providing your contact information, we will not be able to help connect you with rabies prevention services.

First and last name of person(s) involved in the possible rabies exposure (bite victim, owner of exposed pet):

First and last name of person completing this survey, if different from above:

Phone number to contact for follow up:

Email address to contact for follow up:

County of residence of person(s) involved:

* must provide value

State of residence of person(s) involved:

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Country of residence of person(s) involved:

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State where possible rabies exposure occurred:

* must provide value

Country where possible rabies exposure occurred:

* must provide value

County where possible rabies exposure occurred:

* must provide value

Provide as much detail as possible about the exposure location (city, street, building, name of trail, park, or recreation area, etc.):

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.