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Coronavirus 19 (COVID-19) Survey

This survey is to find out more about Coronavirus 19 (COVID-19), how it spreads, as well as your personal experience and opinions related to the pandemic.

This survey may or may not help you. The information you provide may help others.

Your answers and any information collected by Survey Monkey (e.g., IP address) will remain anonymous.

By completing this survey, you imply consent to the use of your information in summarized or aggregate form.

Estimated time to complete is 10 minutes. 
Thank you in advance for your valuable time!

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* 1. My age

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* 2. My gender

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* 3. Number in my household

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* 4. My position in my household

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* 5. My country (optional)

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* 6. I am employed

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* 7. COVID-19 prevents me from working

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* 8. My job title is

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* 9. I work (check only the boxes that best apply to you)

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* 10. All of the adults in my family need to work outside the home to support our family

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* 11. I first learned about COVID-19 on this date

Date

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* 12. I believe that COVID-19 is a true pandemic

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* 13. I believe I have had direct contact with someone infected with COVID-19

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* 14. I believe I have COVID-19 symptoms

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* 15. If "Yes", please list your symptoms in one line separated by commas

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* 16. If "Yes" what date did you first develop symptoms

Date

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* 17. Please check all that apply

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* 18. My test results were positive

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* 19. My current status

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* 20. A member of my household was infected with COVID-19

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* 21. Check all that apply

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* 22. My household member

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* 23. My household member recovered on

Date

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* 24. I know someone not in my household with COVID-19

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* 25. I have had direct contact with this person in close physical proximity

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* 26. I had contact with this person on

Date

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* 27. This person was (check all that apply)

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* 28. This person died from COVID-19

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* 29. When did this person die from COVID-19

Date

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* 30. I first learned about COVID-19 (select one of the following)

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* 31. I have learned about COVID-19 mostly from

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* 32. I believe the information I have about COVID-19 is accurate

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* 33. I have travelled since the COVID-19 outbreak

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* 34. Reason for travel

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* 35. I was away from home when COVID-19 broke out and I have to return quickly

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* 36. I travelled outside of my country

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* 37. I and my household have been socially isolated and have practiced social distancing since learning of the outbreak

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* 38. I learned about COVID-19 and its risks on

Date

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* 39. My household and I strictly respect the mandate for social isolation

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* 40. My friends, neighbors, and workmates strictly respect the mandate for social isolation

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* 41. My household prepared for a global pandemic (such as COVID-19)

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* 42. I believe my household has enough resources (food/shelter/services)

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* 43. My government is working effectively to prevent the COVID-19 spread

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* 44. My government has the resources to (check all that apply)

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* 45. I believe more restrictions are required to prevent COVID-19 spread

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* 46. Compared to annual influenza and other respiratory viruses, COVID-19 is

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* 47. Additional restrictions (please list in one line, with each separated by a comma

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* 48. Please briefly share your story or any additional information you feel is important

0 of 48 answered
 

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