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Coronavirus Preparedness
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1.
First and last name:
(Required.)
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2.
Email address:
(Required.)
3.
Cell Phone:
4.
Facility:
5.
Department:
6.
Shift:
7.
How would you categorize your facility's preparedness for a possible Coronavirus outbreak?
Prepared
Somewhat prepared
Not sure
Somewhat unprepared
Unprepared
8.
In what areas do you feel your facility is unprepared?
Patient isolation areas
Protective personal equipment
Patient ID
Worker education
Other (please list)
9.
What kinds of protective personal equipment does your facility need?
Coveralls that are impervious to viral penetration
Powered air-purifying respirator (PAPR)
Goggles
N95 respirator
Gloves
Facemasks
Gowns
Other (please list)
10.
Is your facility allowing pregnant or immunocompromised nurses to have a modified assignment (no patients with respiratory issues)?
Yes
No
I don't know
Comments:
11.
Other comments or questions:
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12.
Can MNA Staff reach out to you for follow up?
(Required.)
Yes
No
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13.
Can MNA use this information and share the data publicly possibly including your name?
(Required.)
Yes
No
