Tell Us About Your Health Impact Assessment

If you or your organization is currently working on, or has completed, a health impact assessment in the United States, we would love to hear about it! By submitting the following information and sharing your successes and challenges, you will help us build a stronger HIA field and advance smarter policies for healthier communities. To promote your work and allow others to learn from your experiences, we will integrate submissions into our searchable directory.

STEP 1
STEP 2

Project Contact:

Lead Organization: *

Organization Web Site: *

Title:

Email: *

Phone:

City: *

State: *

Zip: *

Partner Organization(s):

Subject of the HIA *

Project Status:

Is the HIA in progress, complete or planned for the future? What is the expected completion date? *

Please provide a brief overview of your project. What decision will/did your HIA inform? If your HIA is complete, did your HIA recommendations influence the decision or decision-making process? *

Is there an online report available for your HIA? If so, please include please include the link here.

Is there a Web site for your HIA? If so, please include the URL here.

Are there any additional materials or products created for your HIA? If so, please include the links to additional materials here.

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Part 2: Additional Project Information (Optional)

If you are willing to provide the Health Impact Project with more information about your HIA, please use the fields below to answer the following questions. Skip this Section »

Tell us about the policy, program, or project that the HIA addresses/addressed.

Who are/were the decision makers for this project?

What level of government decision making does your HIA's policy, program or project address?

What are/were the main health issues?

What are/were the main recommendations that you will make/made?

What strategies do you plan to use, or did you use, to advocate for the recommendations to be adopted?

What challenges do you expect to, or did you, experience?

What do/did you see as the biggest value in conducting the HIA?

If the HIA is complete, what was the outcome of conducting the HIA? Were the HIA recommendations adopted or implemented in some way? What were the impacts of your HIA?

Please provide a cost estimate of your HIA in terms of staff time and dollars (this does not need to be exact).

Please provide an estimate of the duration on the length of time it took to carry out the HIA.

Do you have an image related to your project that you are willing to share?**
NOTE: Images cannot exceed 2MB in size and must have a .jpg, .png, .tif, .tiff, or .pdf file extension.

**Disclaimer

You hereby grant to The Pew Charitable Trusts ("Pew") and the Robert Wood Johnson Foundation a nonexclusive, irrevocable, perpetual, worldwide, royalty-free, sublicensable license for noncommercial purposes to use, display, perform, reproduce, publish, copy, summarize, excerpt, license others to use and distribute the information, including without limitation any HIA or summary thereof provided by you on the HIA Intake Form (the "HIA Information"), and to modify, improve upon and make derivative works based on the HIA Information, and to authorize others, including without limitation the Health Impact Assessment Clearinghouse and Learning Center, to do so.  In addition, you grant to Pew the use of your organization's name in connection with the HIA Information. You represent and warrant that the HIA Information does not infringe upon any third party's intellectual property rights and that you have the right to provide the HIA Information on the HIA Intake Form. Finally, you agree to indemnify, defend and hold harmless Pew and its officers, directors, employees, agents, affiliates and contractors from and against any and all claims, liabilities, damages, losses, expenses, demands, suits and judgments, including without limitation reasonable attorneys' fees and costs, arising from or relating to the HIA Information.

I have read and agree to the disclaimer.

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Tell Us About Your Health Impact Assessment

Project Contact:

Project Status:

Part 2: Additional Project Information (Optional)

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