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* 1. How many people are in your household?

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* 2. Do you and can you wear a mask, if so what kind do you use?

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* 3. Are you currently working? If so, what is your current job?

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* 4. Do you carpool or share space with anyone outside of your household on a regular basis?

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* 5. Does anyone in your household work in a high traffic environment? If so what are they doing?

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* 6. How do you get your groceries or regular shopping done currently?

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* 7. How often do you go to restaurants or bars, and do you dine in or get carry out?

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* 8. Are you or anyone in your household currently undergoing regular care at a hospital?

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* 9. Are there any children in your household or bubble currently undergoing care at daycare or in person learning?

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* 10. What is your email address so that we may contact you with your results:

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