Coronavirus Preparedness Question Title * 1. First and last name: Question Title * 2. Email address: Question Title * 3. Cell Phone: Question Title * 4. Facility: Question Title * 5. Department: Question Title * 6. Shift: Question Title * 7. How would you categorize your facility's preparedness for a possible Coronavirus outbreak? Prepared Somewhat prepared Not sure Somewhat unprepared Unprepared Question Title * 8. In what areas do you feel your facility is unprepared? Patient isolation areas Protective personal equipment Patient ID Worker education Other (please list) Question Title * 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) Question Title * 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 Question Title * 11. Other comments or questions: Question Title * 12. Can MNA Staff reach out to you for follow up? Yes No Question Title * 13. Can MNA use this information and share the data publicly possibly including your name? Yes No Next
