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Is your institution/organization currently implementing any AI related program?   Yes No

AI related program

1. AI Prevention Interventions   Communication     Development of IEC materials     Public Awareness :Please specify:(Mass Media, Campaign, Inter Personal Communication (IPC))     Information sharing (please specify)   Training to Village Health Support Groups, Animators, Animal Agents, NGOs, CBOs, Private Sector, etc.   Others (specify) 2. Outbreak Response (Surveillance and investigation)   Training on avian influenza awareness to the community (specify the target audience)   support communication (specify)   Provide technical assistance or other human resources   Training of private providers   Training public clinicians to all other provinces   Conduct regular refresh training to clinicians (public and private sector)   Development of IEC materials (specify)   Other supports during the outbreak     Masks and alcohol hand rub and PPE specifically for investigators.     Per diems and travel expenses for government staff involved in the investigation     Funds for local radio broadcast of public education messages and loud speaker announcements.     Reporting suspected cases of AI in human     Reporting high mortality of poultry 3. Infection control   Infection Control Training   Support to purchase PPE   IEC development on infection control (specify)   Construction of isolation area 4.Pandemic Preparedness Planning Tips: Please be noticed that this section should be completed if the organization supports the Royal Government of Cambodia in the preparation of the plan. This does not include your internal pandemic plan   Emergency planning   Development of IEC (Specify)   Public information   Social distancing   Training (specify)   Drills and exercises   Home care   Stock of food supplies   Maintenance of essential services   PPE supplies to protect health care workers   Infection control training for staff   Medicines to treat patients   Medical supplies and equipment   Ambulance   Other (specify)

Some general questions for those that are not currently implementing AI but could be helpful in responses to AI outbreak or human to human (H2H) potential pandemic

1. Have you heard of Avian Influenza?   Yes No 2. Has your organization received any AI training or education?   Yes No 3. In case of an outbreak, can you support any of the following?   Report to the central level through hotlines if seen any abnormally sick or dead of poultry   Report to the central level through hotlines if seen AHI suspected cases   Other logistic support such as loud speakers for announcement, incentive to the government staff who do the investigation, etc)   Basic education or awareness 4. Does your organization have an internal pandemic preparedness plan (a plan to address contingency for human to human transmission of pandemic influenza)?   Yes No 5. Does your organization have AI contingency plan (a plan to address contingency animal to human transmission of AI)?   Yes No

Geographical areas of work

Location: Whole Country Banteay Meanchey Battambang Kompong Cham Kompong Chhnang Kompong Speu Kompong Thom Kompot Kandal Koh Kong Kratie Mondul Kiri Phnom Penh Preah Vihear Prey Veng Pursat Rotanak Kiri Siem Reap Sihanouk Ville Stueng Treng Svay Rieng Takeo Otdar Mean Chey Krong Kep Krong Pailin

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