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COVID-19 Survey
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1.
I have/had COVID-19.
(Required.)
Yes
No
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2.
A close friend/family member/care provider has/had COVID-19.
(Required.)
Yes
No
3.
COVID-19 has had an increased impact on my life because of my SCI/D.
Yes
No
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4.
I leave my home:
(Required.)
Less than once/week
0-1 times/week
2-4 times a week
More than 4 times a week
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5.
I wear a mask/facial protection:
(Required.)
Never
Whenever I’m in public
Whenever I’m near others
Only when one is required (shopping, doctors office, etc.)
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6.
I think Shelter In Place protocols:
(Required.)
Should be extended depending on locale
Should be extended until there’s a vaccine
Should end ASAP
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7.
I will be ready to resume traveling:
(Required.)
Resume? I never stopped
Once elected officials/scientists give the green light
When the virus slows down
Once there is a vaccine
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8.
I think my life will be back to "normal" in:
(Required.)
Zero to two months
This fall/winter
Sometime in 2021
Once there is a vaccine
Never
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9.
COVID-19 has impacted my life in the following ways : (check all that apply)
(Required.)
Loss of income/benefits
Scheduling difficulties w/PCA or nurses
Social isolation
Difficulty securing/Lack of needed supplies
Physical/health issues (non-COVID)
Other (please specify)
10.
Please use this space to share your story and address any COVID-related issues you have faced.
Current Progress,
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