Pondera County COVID-19 Community Survey Question Title * 1. What is your age? Under 18 18-24 25-34 35-44 45-54 55-64 65+ OK Question Title * 2. What is your current gender identity? Male Female Other (please specify) OK Question Title * 3. What is your race? White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race OK Question Title * 4. Were you employed prior to the COVID-19 pandemic? Yes No OK Question Title * 5. What is your occupation? Healthcare, Public Health, Human Services Law Enforcement, Public Safety, First Responders Education Child Care Provider Hospitality or Food Service Food and Agriculture Construction Retail and small Business Owner Communication and Information Technology Other Community Based Essential Functions and Government Operations (transportation, public works, waste, etc) Critical Manufacturing Energy Retired I am currently unemployed due to COVID-19 Other (please specify) OK Question Title * 6. Has your job been impacted by the spread of COVID-19, or do you expect it to be impacted? Yes No Unsure (please specify how) OK Question Title * 7. Have you or your family's health (physical and/or mental health) been directly affected by the COVID-19 pandemic? Please explain how. A great deal A lot A moderate amount A little None at all (please specify) OK Question Title * 8. What Montana assistance program(s) do you (or your family) anticipate accessing or have accessed to support yourself (or your family) during the COVID-19 pandemic. Select all that apply. SNAP (provides supplemental food and nutrtion assistance for low income families) TANF (cash assistance program providing temporary financial assistance to needy families. Health Coverage Assistance (Medicaid, Healthy Montana Kids) WIC (healthcare and nutrtion for low-income pregnant women, breastfeeding women and children under age 5) Childcare Subsidy (Best Beginnings Scholarship) supports childcare costs Unemployment Insurance None Other (please specify) OK Question Title * 9. Do you have children under age 18 living in your household? Yes No OK Question Title * 10. What kind of support or other services would be most helpful to you during the pandemic? OK Question Title * 11. Did you access any of Pondera County Health Departments (PCHD) services during the pandemic? Check all that apply. Immunizations WIC Tobacco Prevention Comprehensive Cancer Program Emergency Preparedness (getting PPE, sanitizer, supplies related to COVID-19) Environmental Health Car Seat Safety Blue Cross Blue Shield Care Van Clinics Mental Health Resources None Other (please specify) OK Question Title * 12. How did you hear about the services you accessed? Facebook Website Newspaper Radio Healthcare Provider Friend or Relative Posters/flyers NA Other (please specify) OK Question Title * 13. In what ways did you access educational matrials, information regarding COVID-19 and data? PCHD's Website PCHD's Facebook page Press Releases Montana Department of Health & Human Services (DPHHS) website Other (please specify) OK Question Title * 14. Did you find the information you gained from the resources in #13 helpful? Extremely helpful Very helpful Somewhat helpful Not so helpful Not at all helpful OK Question Title * 15. Did you find the information you gained from the resources in question #13 to be clear and easy to understand? Very easy Easy Neither easy nor difficult Difficult Very difficult OK Question Title * 16. Rate PCHD's response efforts in the community to the COVID-19 pandemic. (1 being lowest, 5 being highest) OK Question Title * 17. We would welcome any ideas or comments to help improve our response efforts to COVID-19. OK DONE
