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* 1. Where do you live?

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* 2. What is your age?

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* 3. Which race/ethnicity best describes you? (Please choose only one.)

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* 4. What is your gender identity?

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* 5. What language do you mainly speak at home?

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* 6. Which statement about re-opening is closest to your thoughts:

A. Most people need to stay home until we have a vaccine or treatment for COVID-19.

B. We need to re-open our community now and deal with the health consequences as we build immunity and recover economically.

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* 7. As our local community takes steps to resume normal activities, how concerned are you about  following:

  Very Concerned Somewhat Concerned Not Concerned Unsure/Don't Know N/A
Overall health of you and your family
Likelihood that you or someone in your family will get COVID-19
Overall health and safety of vulnerable populations (older adults and those with chronic health issues)
Not having the right information to make the best choices about going out
My behaviors impacting the health of vulnerable populations
People not wearing masks in public
People not keeping physical distance in public places

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* 8. How concerned are you out the following :

  Very Concerned Slightly Concerned Moderately Concerned Not Concerned Unsure/Don't know N/A
Becoming or continuing to be unemployed
An economic recession
The loss of locally owned or small businesses
Access to childcare so you can return to work
Access to the internet/public computers

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* 9. How would you say your household spending has changed for the following types of purchases since the COVID-19 public health emergency began in March 2020?

  Decreased Stayed the Same Increased

Don't Know
Groceries
Alcohol
Cannabis /Cannabis Products
Restaurants
Fast Food
Clothes, Beauty, Personal Grooming
Fitness and Recreation (including classes, gym memberships, personal training)
Entertainment (including subscriptions for streaming services, videogames, etc)
Home Goods and Furnishings
Home Renovations
Appliances, Cars or Other Large Purchases

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* 10. If you decreased participation/spending since the pandemic began, what lead to that decrease?

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* 11. After public health guidelines allow for the following activities, please indicate how soon you anticipate returning to your normal habits:

  As soon as possible   1-4 weeks 1-5 months 6-11 months 12 months or longer Unknown
Shopping in retail stores
Dining in restaurants
Visiting entertainment venues
Making large purchases
Attending community events

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* 12. Which of the following applies to you?

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* 13. When restrictions are lifted and allow for the following activities, would you feel comfortable doing the following. If you don't regularly participate in one of these activities, select Not Applicable:

  Very Comfortable Moderately Comfortable Neither Comfortable nor Uncomfortable Moderately Uncomfortable Very Uncomfortable Not Applicable
Working out at the Bob L. Burger Recreation Center
Visiting the Lafayette Public
Visiting the Lafayette Senior Center
Visiting the Lafayette Collective Community  Arts Center
Participate in a city-sponsored outdoor class (10 or more participants)
Participate in group sports
Going to a bar or restaurant
Eating on a restaurant patio
Eating in open area with food trucks
Using a playground in a city park
Attending a community event (50 or more people)
Attending a large event (250 or more people)
Attending a drive-in movie
Attending a drive-in music concert

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* 14. Please select types of virtual (online) programs you or members of your household would attend if the city provided them.

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* 15. Would you or members of your household pay for virtual (online) events such as fitness classes or livestreamed performances?

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* 16. How likely are you to use temporary outdoor seating if offered in a restaurant's parking lot or along business frontage?

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* 17. How likely are you to leave your home to go to work once restrictions are lifted?

 

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* 18. Before the COVID-19 pandemic, how many days per week did you commute to work?

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* 19. How likely are you to use modes of travel other than single occupancy vehicle as your primary mode of transportation once restrictions are lifted?

  Very likely. Somewhat likely Not likely
Bus
Rideshare (Lyft, Uber, etc)
Carpool
Bike

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* 20. Before the COVID-19 pandemic, how often did you travel by modes other than a single occupancy vehicle?

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* 21. Will you continue to wear a face covering once restrictions are lifted?

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