Child Care Survey

Question Title

* 1. Please enter your name and contact information

Provider Name *

Business Name (If Different)

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

County *

Email Address

Phone Number *

Question Title

* 2. Name of Director/Owner/Person completing survey

Question Title

* 3. Program Type

Question Title

* 4. Are you currently a registered Critical Care Site?

Yes

Question Title

* 5. If you answered yes to Question 4, are you currently caring for children?

Yes

Question Title

* 6. If you are a registered Critical Care Child Care site, how many tests will be needed to test each staff member (or household member, including you as the provider) at your site?

Question Title

* 7. If you are a registered Critical Care Child Care site, how many tests will be needed to test each child at your site?

Question Title

* 8. If you are a registered /licensed but currently closed child care site, how many tests will be needed to test each staff member (or household member, including you as the provider) at your site?

Question Title

* 9. If you are a registered/licensed but currently closed child care site, how many tests will be needed to test each child at your site?

Question Title

* 10. When the Governor’s Order is lifted, how much time do you need to get your program up and running?

Other (please specify)

Question Title

* 11. What supports do you need now to either keep your Critical Child Care site operating or reopening your child care program?

Funding

Supplies

Staffing

Other (please specify)

Question Title

* 12. If you need funding, please describe: For what? For how long? How much?

Question Title

* 13. If you need assistance with supplies, please select all that apply

Paper products (toilet paper, paper towels, tissues, etc.)

Cleaning supplies (hand sanitizer, bleach, soap, wipes)

Baby supplies

Food

Other (please specify)

Question Title

* 14. Are you ready to call staff back to work?

Yes

If No, why not?

Question Title

* 15. Is your program prepared to offer infant care?

Yes, immediately

No, we need time

Not Applicable, I/we do not offer this type of care

If No, please describe why not.

Question Title

* 16. Is your program prepared to offer Toddler care?

Yes, immediately

No, we need time

Not Applicable, I/we do not offer this type of care

If No, please describe why not.

Question Title

* 17. Is your program prepared to offer Preschool care?

Yes, immediately

No, we need time

Not Applicable, I/we do not offer this type of care

If No, please describe why not.

Question Title

* 18. Is your program prepared to offer School Age care?

Yes, immediately

No, we need time

Not Applicable, I/we do not offer this type of care

If No, please describe why not.

Question Title

* 19. If you indicated that you were unprepared to provide care in questions 15 - 18, please select a reason from the below list. Choose any that apply.

Space

Materials

Staffing

Other (please specify)

Child Care Survey - Covid 19

Question Title

* 1. Please enter your name and contact information

Question Title

* 2. Name of Director/Owner/Person completing survey

Question Title

* 3. Program Type

Question Title

* 4. Are you currently a registered Critical Care Site?

Question Title

* 5. If you answered yes to Question 4, are you currently caring for children?

Question Title

* 6. If you are a registered Critical Care Child Care site, how many tests will be needed to test each staff member (or household member, including you as the provider) at your site?

Question Title

* 7. If you are a registered Critical Care Child Care site, how many tests will be needed to test each child at your site?

Question Title

* 8. If you are a registered /licensed but currently closed child care site, how many tests will be needed to test each staff member (or household member, including you as the provider) at your site?

Question Title

* 9. If you are a registered/licensed but currently closed child care site, how many tests will be needed to test each child at your site?

Question Title

* 10. When the Governor’s Order is lifted, how much time do you need to get your program up and running?

Question Title

* 11. What supports do you need now to either keep your Critical Child Care site operating or reopening your child care program?

Question Title

* 12. If you need funding, please describe: For what? For how long? How much?

Question Title

* 13. If you need assistance with supplies, please select all that apply

Question Title

* 14. Are you ready to call staff back to work?

Question Title

* 15. Is your program prepared to offer infant care?

Question Title

* 16. Is your program prepared to offer Toddler care?

Question Title

* 17. Is your program prepared to offer Preschool care?

Question Title

* 18. Is your program prepared to offer School Age care?

Question Title

* 19. If you indicated that you were unprepared to provide care in questions 15 - 18, please select a reason from the below list. Choose any that apply.

Question Title

* 20. What else do we need to know about child care during this time to help you either as Critical Child Care Sites or to reopen when the time comes?