COVID-19 Impact Survey for Employees

Employment

What industry do you currently work in?*

What is your current role?*

What is your age?*

Hidden

Do you feel like you have job security for the next:

Check all that apply.

30 days

60 days

90 days

N/A

Do you feel like you have job security for the next:*

30 days

60 days

90 days

My job is secure for the foreseeable future

Unsure

Do you feel like your employer is doing all that they can to support your safety and well being while working?*

Yes

No

Are you able to work from home?*

Yes

No

Do you have what you need to perform your job from home?*

Yes

No

What tools/resources do you need?*

Are you currently looking for additional ways to earn income?*

Yes

No

What is your home zip code?*

Health

Do you feel like you would be able to access COVID-19 related health services if you needed them?*

Yes

No

Do you currently feel comfortable going to the doctor for other medical needs?*

Yes

No

Do you feel like you are finding adequate ways to connect with friends and family during this time?*

Yes

No

Do you have any ideas on what might help?*

Do you have access to mental health services if you needed them?*

Yes

No

Is there anything else you would like to share with us?

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