PACE EH USERS PROFILE
Contact Information (The items marked with red asterisks (*) are required.)
*Name:
Title:
City/County:
Address:
Address 2:
City:
State:
Zip Code:
Telephone:
Facsimile:
*E-mail:
Website URL:
Demographics:
Jurisdiction Population Size
Geographic Size

Background:
(e.g., agency/organizations responsibilities, number of staff, operating budget)

Beginning of the PACE EH process:
[e.g., logistics: (staff time, resources, partners) implementation; modifications to the process; establishing a CEHA team)

Environmental health issues identified - in order of importance:
1. 2.
3. 4.
5. 6.
7. 8.
9. 10.
How the above information was collected and what criteria were used for the issue:

Developing Indicators:

Please explain your ranking & prioritizing:

Action plan: (developed as a result of the PACE EH process)

Current status of PACE EH project:

Tools and materials developed:
Please briefly describe the main tools and materials developed and used for the PACE EH process. When possible, we request that either an electronic version of the tools and materials be sent via email or a hard copy mailed to NACCHO for inclusion in further iterations of PACE EH in Practice.

If you have any questions or would like more information about
NACCHO’s Community Environmental Health Assessment programs
please contact Jonathan Schwartz at jschwartz@naccho.org or (202) 783-5550 x250.
Thank you.