COVID- 19 Workplace survey

Question Title

* 1. Name of the facility in which you work

Other (please specify)

Question Title

* 2. What type of department/unit do you work in?

Other (please specify)

Question Title

* 3. Do you work at a facility that has cared for patients with known or suspected COVID-19?

Yes

Unsure

Question Title

* 4. Have you provided direct care to a patient with known or suspected COVID-19?

Yes

Unsure

Question Title

* 5. How were you informed that you would be caring for a patient with suspected or confirmed COVID-19, including who informed you and when, in relation to your shift?

Question Title

* 6. Has management communicated actions to take if you believe you have been exposed to a patient with known or suspected COVID-19 or if you exhibit symptoms (e.g., fever, cough, shortness of breath)?

Manager notified me

Employee health notified me

I learned from the media

Nobody notified me

Other

Question Title

* 7. What steps did the employer recommend you take?

Follow CDC Guidelines

Follow advise from employee health

I still have unanswered questions

Comment

Question Title

* 8. Were you instructed to stay home from work? (check all that apply)

I was furloughed

I was told to stay home by my manager

I was told to stay home by employee health

I chose to stay home

Question Title

* 9. If you were instructed to stay home from work, is the employer paying you or did the employer instruct you to use PTO/EIB or file for worker’s compensation?

My employer is paying me

Using my PTO or EIB

I don’t know

My employer instructed differently

Question Title

* 10. Currently, do you feel prepared to provide care for a patient with known or suspected COVID-19?

Yes

Unsure

Question Title

* 11. Does your facility have a plan in place to care for those with known or suspected COVID-19?

Yes

Unsure

Question Title

* 12. Is there a place in your facility to screen and triage patients who come into the facility to make sure that patients with possible COVID-19 are isolated?

Yes

Unsure

Question Title

* 13. Does the facility have negative air pressure rooms?

Yes

Unsure

Question Title

* 14. Do you know where they are located?

Yes

Unsure

Question Title

* 15. Does the facility have N95 respirators available?

Yes

Unsure

Question Title

* 16. Is yearly N95 respirator fit testing been provided?

Yes

Unsure

My unit uses another type of respirator that does not require fit testing (i.e. CAPR)

Question Title

* 17. Does your facility have PAPRs or reusable respirators?

Yes

Unsure

Question Title

* 18. Do you have access to adequate supplies of PPE (respirators, eye protection, face shield, gloves) to do your work?

Yes

Unsure

Question Title

* 19. Has management assigned/asked for staff volunteers dedicated to care for patients with COVID-19?

Yes

Unsure

Question Title

* 20. Has your management/supervisor discussed with frontline staff your facility’s response plan for caring for patients with known or suspected COVID-19?

Yes

Unsure

Question Title

* 21. What type of preparation and training has your facility conducted? (check all that apply)

Adding questions to intake screening

Posting of CDC checklist for patients with known or suspected COVID-19 on your unit

Posting phone number of state Department of Health

Plan for patient transport from clinic/community to ED

Plan for patient transport from ED to inpatient setting

Setting up separate screening areas for potential patients

Setting up isolation areas specific for patients with known or suspected COVID-19

CDC recommended personal protective equipment (PPE) is immediately available to staff

CDC recommended PPE kits ready for use and practice for clinic, public health, ambulatory setting

CDC recommended PPE kits ready for use and practice for ED or Urgent Care setting

Training staff on current infection control protocols

Employer-provided training on when to use PPE, donning, and doffing.

Discussed safety and patient care delivery in daily huddle

Clinical protocols for aerosol-generating procedures (bronchoscopy, intubation, CPR, respiratory suctioning, etc.)

Appropriate cleaning materials

I do not know

Other (please specify)

Question Title

* 22. If training is being conducted, what methods of instruction are being used?

None

General meetings/forums

Literature provided

Videos

Webinars

Inservices/huddles

Review of updated PPE procedures

Repetitive hands-on drills appropriate to your role including donning and doffing PPE.

Question Title

* 23. Are you afraid to come to work?

If Yes, please explain

Question Title

* 1. Name of the facility in which you work

Question Title

* 2. What type of department/unit do you work in?

Question Title

* 3. Do you work at a facility that has cared for patients with known or suspected COVID-19?

Question Title

* 4. Have you provided direct care to a patient with known or suspected COVID-19?

Question Title

* 5. How were you informed that you would be caring for a patient with suspected or confirmed COVID-19, including who informed you and when, in relation to your shift?

Question Title

* 6. Has management communicated actions to take if you believe you have been exposed to a patient with known or suspected COVID-19 or if you exhibit symptoms (e.g., fever, cough, shortness of breath)?

Question Title

* 7. What steps did the employer recommend you take?

Question Title

* 8. Were you instructed to stay home from work? (check all that apply)

Question Title

* 9. If you were instructed to stay home from work, is the employer paying you or did the employer instruct you to use PTO/EIB or file for worker’s compensation?

Question Title

* 10. Currently, do you feel prepared to provide care for a patient with known or suspected COVID-19?

Question Title

* 11. Does your facility have a plan in place to care for those with known or suspected COVID-19?

Question Title

* 12. Is there a place in your facility to screen and triage patients who come into the facility to make sure that patients with possible COVID-19 are isolated?

Question Title

* 13. Does the facility have negative air pressure rooms?

Question Title

* 14. Do you know where they are located?

Question Title

* 15. Does the facility have N95 respirators available?

Question Title

* 16. Is yearly N95 respirator fit testing been provided?

Question Title

* 17. Does your facility have PAPRs or reusable respirators?

Question Title

* 18. Do you have access to adequate supplies of PPE (respirators, eye protection, face shield, gloves) to do your work?

Question Title

* 19. Has management assigned/asked for staff volunteers dedicated to care for patients with COVID-19?

Question Title

* 20. Has your management/supervisor discussed with frontline staff your facility’s response plan for caring for patients with known or suspected COVID-19?

Question Title

* 21. What type of preparation and training has your facility conducted? (check all that apply)

Question Title

* 22. If training is being conducted, what methods of instruction are being used?

Question Title

* 23. Are you afraid to come to work?

Question Title

* 24. What additional information do you need to feel safe and informed (e.g., effectiveness of employer response, resources, personal support)?

Question Title

* 25. Additional Comments (is there anything else your union can be doing?)

Question Title

* 26. Contact Information (Optional)