COVID-19 Survey

The County of Riverside is interested in learning what more needs to be done to ensure homeless individuals and the people and organizations who serve them are prepared to prevent and address the spread of COVID-19 (the Coronavirus). If you serve homeless people, we thank you for taking 5 minutes to answer this survey.  For more information, please go to: https://www.rivcoph.org/coronavirus.

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* 1. What is your agency name?

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* 2. If your agency provides housing or program space where people are in close quarters, what is the maximum number of people using that space on a  regular basis?

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* 3. How often do you provide services?

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* 4. Where do you provide services?

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* 5. Do any of your employees have fever, shortness of breath, and are coughing?

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* 6. Which medical provider does your facility have a strong relationship with? (Referral or formal relationship)  Please list the most contact/used provider.

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* 7. Do all your employees have paid sick time or other time they can use when sick?

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* 8. If some or all employees DO NOT have paid time off if sick, HOW MANY employees do not have paid time off? Skip if this does not apply.

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* 9. We are interested in knowing your agency's preparedness to respond to COVID-19. Please check all that apply:

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* 10. Thank you for completing this survey. Please give us the contact for your agency and let us know if you any other questions or concerns.

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