COVID-19 Recovery and Support Community Survey (Individual Community Members)

About the Survey

We want to support our local community during COVID-19. We’ve created the COVID-19 Community Recovery and Support Survey to understand the issues you’re facing and advocate to State and Federal Government on your behalf.

capel.wa.gov.au/covid19

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* 1. Your Contact Infomation

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Marital Status

Single

Married

De Facto

Single Parent

Two Parents with Children

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* 3. Age

0-9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

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* 4. Do you live alone?

Yes

COVID-19 Recovery and Support Community Survey (Individual Community Members)

About the Survey

Question Title

* 1. Your Contact Infomation

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* 2. Marital Status

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* 3. Age

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* 4. Do you live alone?

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* 5. Do you identify as culturally and linguistically diverse?

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* 6. Have you or a family member had to self-isolate under Western Australian Health Guildelines?

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* 7. What challenges are you facing as a result of COVID-19?

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* 8. What support would help you during this time?