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* 1. What are the best parts about your community? Select all that apply.

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* 2. How do you connect or socialize with others in your community?

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* 3. Choose the following statement(s) you agree with

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* 4. During the past year, I and/or someone in my household was treated unfairly in my community (If you answer Disagree, Skip to question 7).

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* 5. I believe the unfair treatment was based on these reasons. Select all that apply.

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* 6. In what situations have you/or your household member(s) experienced unfair treatment in your community? Select all that apply.

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* 7. During the past year, if you or someone in your household missed work, a medical appointment, or other important events because you had no transportation, which of the following caused this problem? Select all that apply.

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* 8. In the past year, how often have you worried that you would run out of food before you had money to buy more? Choose one.

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* 9. Where do you get most of your food? Choose one.

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* 10. What is your living situation today? Choose one.

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* 11. Do any of the following impact your ability to keep your job or move up in your job? Select all that apply.

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* 12. Does your housing meet your needs? (Affordable, safe, enough room for everyone, etc.)

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* 13. Does your household have enough money to pay for basic needs like food, clothing, housing, etc.?

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* 14. What do you think the most important areas for community improvement are relating to health behaviors and outcomes? Select all that apply.

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* 15. What do you think the most important areas for community improvement are relating to social and economic factors? Select all that apply.

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* 16. What do you think the most important areas for community improvement are relating to clinical care? Select all that apply.

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* 17. What do you think the most important areas for community improvement relating to the physical environment? Select all that apply.

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* 18. What is preventing the residents who live in our county from achieving optimal health?

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* 19. What is your main source of information about a disaster or emergency or event?

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* 20. Do you and your household have an emergency plan, including consideration to needs (oxygen, medicine, special care, etc.)

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* 21. Does each person in your household who takes prescribed medication currently have a 7-day supply?

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* 22. In the event of an evacuation or having to relocate, how likely are you to use a shelter?

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* 23. How far do you travel for emergency care?

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* 24. How far do you travel for health care?

Demographics: These questions are asked to compare to the census data.

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* 25. What is your zip code?

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* 26. How many months out of the year do you live at this zip code?

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* 27. What is your age?

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* 28. What is your sex?

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* 29. What language(s) do you speak at home?

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* 30. What is your annual household income?

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* 31. What is the highest level of education you have completed?

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* 32. Choose the option that best describes your current employment status. Choose one.

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* 33. Which category(ies) fit you best?

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* 34. How would you identify your Ethnicity?

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 100% of survey complete.

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