CWH COVID-19 Survey Question Title * 1. Please provide your name and unit: First and Last Name What unit/department do you work? Question Title * 2. What is your number one issue with COVID-19? Question Title * 3. Have you been exposed to COVID-19 at work, either by taking care of a positive patient, positive patient family member or positive co-worker? Yes No If yes, what procedure were you instructed to follow? Question Title * 4. Have you tested positive for COVID-19? Yes No Question Title * 5. Is your current PPE supply adequate? Yes No If no, please provide details Question Title * 6. What types of PPE do you have available in your unit/department? Question Title * 7. How often do you change out your PPE? Question Title * 8. If your PPE is soiled or damaged, do you have easy access to a replacement? Yes No If no, please provide details? Question Title * 9. If you are in an at risk or might be at risk category are you currently working with an accommodation? Yes No Question Title * 10. If you are in one of the high risk or might be at risk categories, did you see your family doctor and provide a note requesting an accommodation? Yes No If no, please provide details?(Your personal medical condition is private. If your answer provides that information, we will keep it confidential.) Thank you for taking the time to complete the survey. If you have any questions, feel free to contact Carmen Garrison, WSNA Nurse Representative, cgarrison@wsna.org. Done
