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Coronavirus questionnaire
Coronavirus Questionaire
*
Indicates required field
What municipality do you live in?
*
Example: Hazleton, Freeland, Hazel Township, etc
Should local schools be closed?
*
Not at all
Not until there are local cases
Yes
Should local public events continue?
*
Yes
Yes, until there are local cases
Yes, with some restrictions
No
How likely are you to attend a public event in the near future?
*
I plan to attend local public events
I may attend local events
I will not attend any local events
How concerned are you with the coronavirus?
*
Not concerned at all
Mildly concerned
Moderately concerned
Very concerned
Are you prepared for the possibility of children being out of school for an extended period of time?
*
Yes
No
N/A
Are you financially prepared to be out of work for an extended period?
*
Yes
Yes, but I will require assistance
No
Has your employer discussed potential impacts of the coronavirus with you?
*
Yes, there are plans in place
Yes, but no plans are in place
No
Have recent events changed your opinion of public places such as gyms, movie theaters, or large stores?
*
No. I continue to visit these places as usual.
Yes. I still visit these places, but I pay more attention to hand washing and sanitization
Yes. I limit my visits to these places
Yes. I will not visit these places
Are you concerned for the health of yourself and loved ones?
*
No. I am not concerned at all
I am mildly concerned
I am very concerned
How would you rate government response to the coronavirus?
*
Government response is exaggerated
Government response is adequate
There is more that can be done
Submit
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