Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. California COVID-19 survey Thank you for taking time to provide feedback. Please be advised this survey is for informational purposes only. If you are experiencing an emergency, please dial 911 or your local authorities. OK Question Title * 1. How are you feeling? I’m doing fine Optimistic Anxious Frustrated Thankful Lonely Other (please specify) OK Question Title * 2. Which actions are you taking? Select all that apply. Gathering with others outside of your household Wearing a mask when outside my home Washing my hands often Continuing to stay home as much as possible Interacting with the public for work Living my life as I want to Staying 6 feet away from others Other (please specify) OK Question Title * 3. How do you feel about the following activities: Very risky Risky Not sure Safe Very safe Gathering indoors with others outside of your household Gathering indoors with others outside of your household Very risky Gathering indoors with others outside of your household Risky Gathering indoors with others outside of your household Not sure Gathering indoors with others outside of your household Safe Gathering indoors with others outside of your household Very safe Sending students and teachers back to school Sending students and teachers back to school Very risky Sending students and teachers back to school Risky Sending students and teachers back to school Not sure Sending students and teachers back to school Safe Sending students and teachers back to school Very safe Eating at a dine-in restaurant Eating at a dine-in restaurant Very risky Eating at a dine-in restaurant Risky Eating at a dine-in restaurant Not sure Eating at a dine-in restaurant Safe Eating at a dine-in restaurant Very safe Visiting a beach or park Visiting a beach or park Very risky Visiting a beach or park Risky Visiting a beach or park Not sure Visiting a beach or park Safe Visiting a beach or park Very safe Shopping (retail, groceries, etc) Shopping (retail, groceries, etc) Very risky Shopping (retail, groceries, etc) Risky Shopping (retail, groceries, etc) Not sure Shopping (retail, groceries, etc) Safe Shopping (retail, groceries, etc) Very safe Going to a bar Going to a bar Very risky Going to a bar Risky Going to a bar Not sure Going to a bar Safe Going to a bar Very safe OK Question Title * 4. Which three are most important to you? (Select three.) Finding a job Keeping me and my family healthy Being free to do as I choose Returning to work Re-building California’s economy Flattening the curve to keep Californians healthy Socializing with family and friends Reopening schools Other (please specify) OK Question Title * 5. Have you or any family or friends gotten sick from COVID-19? Yes No Other (please specify) OK Question Title * 6. How old are you? Under 18 18 - 29 30 - 41 42 - 53 54 - 64 65+ OK Question Title * 7. What is your zip code? OK Question Title * 8. As fellow Californians, we’d like to know how you're doing. Please share anything you think we should know. OK Question Title * 9. What do you think the State should be doing? OK Question Title * 10. Please check here if you consent to allowing the State of California to anonymously use and/or quote your feedback. I agree OK DONE
