Exit this survey COVID-19 Questionnaire Question Title * 1. Full Name: Question Title * 2. Title: Question Title * 3. Community: Question Title * 4. Have you implemented a pay differential? Yes No Question Title * 5. If no, are you considering a pay differential? Yes No Question Title * 6. What is the range of the differential? Question Title * 7. If you are a multi-site, is this differential offered at all communities or selected communities? All Selected Question Title * 8. Is the differential applied to specific positions (e.g. clinical only, clinical and dietary, nurses only) or all positions? All Specific Question Title * 9. Is the differential applicable for service to all residents or only to those serving COVID + or presumed positive residents/patients? All residents Subset of residents/patients Question Title * 10. What is the range of the differential? $x/hour to $y/hour OR %increase/hour? Question Title * 11. What are you calling the differential? 'Appreciation' pay? 'Premium' pay? Question Title * 12. Have you had staff call out due to COVID-19? Yes No Question Title * 13. What are the reasons staff are calling out? Fear of getting sick Family leave to care for sick family member Child care Other (please specify) Question Title * 14. Have you utilized agency staff? Yes No Question Title * 15. Has your use of agency staff increased to fill in because staff has call out due to COVID-19? Yes No Question Title * 16. If yes, how has your agency staff use increased? Please give how many more hours per week you are using agency staff above what you would normally be using? Question Title * 17. Are you using consistent staffing to provide care and services to COVID + or symptomatic residents? Yes No Done
