The Community Health Policy and Planning Office of the Peoria City/ County Health Department is gathering information to better understand our community’s COVID-19 vaccination readiness. The results will help us to address community concerns and provide additional assistance.

The survey will take a few minutes to complete and your responses are anonymous.

Thank you in advance for your participation. If you have any questions regarding the survey, please contact Dr. Leslie McKnight at lmcknight@peoriacounty.org. For questions regarding COVID-19 vaccine, go to https://www.pcchd.org/306/COVID-19-Vaccine-Information. 

 Stay healthy and safe! 

   
Please read each question and check the most appropriate answer.  There are no right or wrong answers

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* 1. Do you know someone personally that has/had COVID-19?

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* 2. When the vaccine becomes available to you, how likely are you to get the vaccine?

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* 3. If you do not plan on getting the vaccine, what are your concerns? Check all that apply

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* 4. What will make you more likely to get a vaccine?  Check all that apply

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* 5. I trust and believe the COVID-19 vaccine is safe and effective

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* 6. I understand the safety of the vaccine

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* 7. I understand how effective the vaccine is

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* 8. Where do you get your information on the COVID-19 vaccine?  Check all that apply

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* 9. What is your gender?

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* 10. What is your age?

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* 11. What is your ethnicity?

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* 12. What is your highest level of education?

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* 13. What is your ZIP code?

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