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Are you 18 years or older?
Are you 18 years or older?
Where are you currently staying?
Where are you currently staying?
We mean the place where you slept last night. This may be different from where you usually stay.
In the last 24 hours, have you had any of the following?
In the last 24 hours, have you had any of the following?
chest pain
difficulty breathing
headache
aches or muscle pain
Fever
Nausea
Eye pain
Loss of smell or taste
Cough
Stuffy or runny nose
sore throat
Fatigue
Chills
Changes to sleep
If answered yes, are the conditions unusual for you?
If answered yes, are the conditions unusual for you?
For how many days have you had at least one of these symptoms?
For how many days have you had at least one of these symptoms?
Do you personally know anyone in your local community who is sick with a fever and either a cough or difficulty breathing?
Do you personally know anyone in your local community who is sick with a fever and either a cough or difficulty breathing?
How many people do you know with these symptoms?
How many people do you know with these symptoms?
Have you spent time with these people in the last 7 days?
Have you spent time with these people in the last 7 days?
Have you ever been tested for coronavirus?
Have you ever been tested for coronavirus?
In the last 24 hours, have you done any of the following?
In the last 24 hours, have you done any of the following?
Gone to work outside the place where you are currently staying
Gone to a market, grocery store, or pharmacy
Gone to a restaurant, cafe, or shopping center?
Spent time with someone who isn´t currently staying with you?
Attended an event with more than 10 people
Used public transportation.
In the last 24 hours, have you worn a mask when you have done any of the following?
In the last 24 hours, have you worn a mask when you have done any of the following?
Gone to a market, grocery store, or pharmacy
Gone to a restaurant, cafe, or shopping center?
Spent time with someone who isn´t currently staying with you?
In the last 24 hours, have you had direct contact with anyone who is not staying with you?
In the last 24 hours, have you had direct contact with anyone who is not staying with you?
Direct contact means spending longer than one minute within two meters of someone or touching, including shaking hands, hugging, or kissing.
How many people, who are not staying with you, have you had direct contact with in the last 24 hours?
How many people, who are not staying with you, have you had direct contact with in the last 24 hours?
In the last 24 hours, about how many times have you washed your hands with soap and water or used hand sanitizer?
In the last 24 hours, about how many times have you washed your hands with soap and water or used hand sanitizer?
0 times
1-2 times
3-6 times
7 or omre times
Do you have access to soap and water for washing your hands at the place where you are currently staying?
Do you have access to soap and water for washing your hands at the place where you are currently staying?
In the last 7 days, have you spent time at a health clinic or hospital (including as an employee, volunteer, visitor, or patient)?
In the last 7 days, have you spent time at a health clinic or hospital (including as an employee, volunteer, visitor, or patient)?
In the last 7 days, how often did you wear a mask when in public?
In the last 7 days, how often did you wear a mask when in public?
In the last 7 days, on how many days did you spend time with people who aren't staying with you?
In the last 7 days, on how many days did you spend time with people who aren't staying with you?
How often are you intentionally avoiding contact with other people?
How often are you intentionally avoiding contact with other people?
all the time / most of the time / some of the time / none of the time
There are two types of flu vaccines. One is a shot and the other is a spray, mist, or drop in the nose. Have you gotten a seasonal flu vaccine since June 2020?
There are two types of flu vaccines. One is a shot and the other is a spray, mist, or drop in the nose. Have you gotten a seasonal flu vaccine since June 2020?
Do you intend to get a seasonal flu vaccine by the end of January 2021?
Do you intend to get a seasonal flu vaccine by the end of January 2021?
Why do you not intend to get a seasonal flu vaccine by the end of January 2021?
Why do you not intend to get a seasonal flu vaccine by the end of January 2021?
During the last 7 days, how often did you feel so nervous that nothing could calm you down?
During the last 7 days, how often did you feel so nervous that nothing could calm you down?
During the last 7 days, how often did you feel so depressed that nothing could cheer you up?
During the last 7 days, how often did you feel so depressed that nothing could cheer you up?
How worried are you that you or someone in your immediate family might become seriously ill from coronavirus (COVID-19)?
How worried are you that you or someone in your immediate family might become seriously ill from coronavirus (COVID-19)?
very worried / somewhat worried / not too worried / not worried at all
How worried are you about having enough to eat in the next week?
How worried are you about having enough to eat in the next week?
very worried / somewhat worried / not too worried / not worried at all
How worried are you about your household’s finances in the next month?
How worried are you about your household’s finances in the next month?
very worried / somewhat worried / not too worried / not worried at all
Do any of the following reasons describe why you are worried about your household's finances in the next month?
Do any of the following reasons describe why you are worried about your household's finances in the next month?
Loss of income
healthcare costs related to coronavirus
healthcare costs not related to coronavirus (including costs to treat other illnesses, diseases, injuries, or symptoms)
In the last 7 days, did you do any work for pay, or do any kind of business, farming, or other activity to earn money, even if only for one hour?
In the last 7 days, did you do any work for pay, or do any kind of business, farming, or other activity to earn money, even if only for one hour?
What is the main activity of the business or organization in which you work?
What is the main activity of the business or organization in which you work?
agriculture
buying and selling
Construction
Education
Electricity / water / gas / waste
Financial / insurance / real estate services
Health
Manufacturing
Mining
Personal Services
Professsional / scientific / technical activities
Public administration
Tourism
Transportation
Other
What is your gender?
What is your gender?
male, female
What is your age?
What is your age?
18-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75 years or older
How many years of education have you completed?
How many years of education have you completed?
Which of these best describes the area where you are staying?
Which of these best describes the area where you are staying?
city, town, village or rural area
How many people slept in the place where you stayed last night (including yourself)?
How many people slept in the place where you stayed last night (including yourself)?
In the place where you are staying, how many rooms are used for sleeping?
In the place where you are staying, how many rooms are used for sleeping?
Do you have a smartphone?
Do you have a smartphone?
Have you installed the following types of coronavirus (COVID-19)-related apps on your smartphone? a contact tracing app? a symptom tracking app?
Have you installed the following types of coronavirus (COVID-19)-related apps on your smartphone? a contact tracing app? a symptom tracking app?
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