1.If you would be willing to talk to a reporter, on or off the record, please tell us your name and contact information below. Otherwise you may answer the survey anonymously if you choose.

Name

City/Town

Email Address

Phone Number

2.Even if you would like to proceed anonymously, please provide the town you live in

3.Has COVID-19 affected your life? If yes, how so?

4.What kind of changes have you seen in your community as a result of COVID-19 concerns? (e.g. changed behaviors, cancelled events, etc.) Are you changing your behaviors? Why or why not, and if yes, how so?

5.Are you satisfied by the response from leaders at the local, state, federal level, and from health-care organizations? Why or why not?

6.What questions do you have about the worldwide COVID-19 outbreak in general? What remains unclear to you?

7.What questions do you have about the outbreak of COVID-19 in your community?

8.What sort of preparations is your workplace undertaking to prepare for COVID-19?

9.If you are a healthcare worker, what are your personal and professional concerns relating to COVID-19 as you care for your general patients?

10.If you are a healthcare worker, what else do you think we should know or consider as our coverage continues?