Climate change threatens human health through a variety of pathways including more frequent extreme weather events, decreased air quality and increased spread of vector-borne diseases. Massachusetts, recognizing this risk, surveyed its local boards of public health to gauge the state’s level of public health preparedness for climate change. The Massachusetts Department of Health was interested in the local boards’ current understanding, level of preparedness and response capabilities for projected climate change risks. The survey covered surveillance, planning and intervention activities associated with heat stress, hazardous weather events, indoor air quality, food supply/agricultural issues, vector-borne diseases and water quality issues. The survey helped identify communities that may be more vulnerable to projected climate change risks. State and local communities can use this knowledge to increase resilience and adaptive capacity by more effectively guiding and targeting resources and actions to vulnerable health departments.