COVID-19 Community Health Needs Assessment

Thank you for participating in our COVID-19 Community Health Needs Assessment. With this survey, we hope to get a better idea of the health needs that exist in the community since the COVID-19 (coronavirus) pandemic started, and how to better meet them going forward. Please answer honestly and carefully. We appreciate your time!

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* 1. Has the COVID-19 (coronavirus) pandemic made any of the these more difficult for you? (Check all that apply)

Housing (paying rent, facing eviction, foreclosure, maintenance, etc)

Job Security (unemployed, got fired or laid off, less work to do than before, less income, etc)

Transportation (getting to places you need to go, riding public transit, driving a car, etc)

Access to food (affording groceries, getting SNAP benefits, feeding family or loved ones, etc)

Utilities (facing electric, gas, or water shut-offs or difficulty paying for them)

Paying bills (medical or other)

Affording other basic needs (not mentioned above)

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* 2. Since the start of the COVID-19 (coronavirus) pandemic, have you tried to get a COVID-19 test near you?

Yes

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* 3. If so, was it easy or difficult was it to get tested?

Easy

Difficult

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* 4. Was it easy or difficult was it to get a result?

Easy

Difficult

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* 5. How many days a week are you exercising?

Once a week

Twice a week

3-4 times a week

5-7 times a week

Other (please specify)

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* 6. Is this more or less than before the COVID-19 (coronavirus) pandemic?

More than before

Less than before

Same as before

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* 7. Since the start of the COVID-19 (coronavirus) pandemic, do you feel that your mental health is better, worse, or stayed the same?

Better

Worse

Same

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* 8. In the last month, how often have you felt nervous or stressed?

Always

Sometimes

Never

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* 9. How often do you feel isolated from others?

Always

Sometimes

Never

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* 10. Would you like to speak to a specialist about any of these topics?

Yes, I would like more information

No, I already have a specialist that I speak with

No, I am not interested in speaking with a specialist

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* 11. Have you had trouble meeting any health needs during the COVID-19 (coronavirus) pandemic?

Yes

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* 12. If yes, what have you had trouble with?

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* 13. What other challenges have you or your family faced during the COVID-19 (coronavirus) pandemic?

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* 14. Would you like to take the flu vaccine?

Yes

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* 15. Would you like to take the COVID-19 vaccine?

Yes

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* 16. What is your racial background?

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

Arab American

Bengali American

Other (please specify)

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* 17. What is your gender identity?

Woman

Man

Non-binary or Genderqueer

Transgender

Not specified above, please specify

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* 18. Which age group are you in?

18-24

25-34

35-44

45-54

55-64

65+

COVID-19 Community Health Needs Assessment

Question Title

* 1. Has the COVID-19 (coronavirus) pandemic made any of the these more difficult for you? (Check all that apply)

Question Title

* 2. Since the start of the COVID-19 (coronavirus) pandemic, have you tried to get a COVID-19 test near you?

Question Title

* 3. If so, was it easy or difficult was it to get tested?

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* 4. Was it easy or difficult was it to get a result?

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* 5. How many days a week are you exercising?

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* 6. Is this more or less than before the COVID-19 (coronavirus) pandemic?

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* 7. Since the start of the COVID-19 (coronavirus) pandemic, do you feel that your mental health is better, worse, or stayed the same?

Question Title

* 8. In the last month, how often have you felt nervous or stressed?

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* 9. How often do you feel isolated from others?

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* 10. Would you like to speak to a specialist about any of these topics?

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* 11. Have you had trouble meeting any health needs during the COVID-19 (coronavirus) pandemic?

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* 12. If yes, what have you had trouble with?

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* 13. What other challenges have you or your family faced during the COVID-19 (coronavirus) pandemic?

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* 14. Would you like to take the flu vaccine?

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* 15. Would you like to take the COVID-19 vaccine?

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* 16. What is your racial background?

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* 17. What is your gender identity?

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* 18. Which age group are you in?

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* 19. What is your zip code?