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

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

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* 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?

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* 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)?

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

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

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* 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?

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

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

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* 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?

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

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* 14. Do you know where they are located?

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* 15. Does the facility have N95 respirators available?

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

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

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

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

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

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

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

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* 23. Are you afraid to come to work?

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

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

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* 26. Contact Information (Optional)

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