The Allen County Department of Public Health is gathering information from the community to assess how prepared we are as a community to endure a local COVID-19 epidemic. The answers you provide will be used by the Allen County Department of Health and other partners to identify needs within the community. The results from this survey maybe shared for greater awareness or used for research.

All responses are anonymous.

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* 1. What zip code do you live in?

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* 2. How many people are there in your household?

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* 3. How many dependent children would you need to find substitute childcare for if schools and childcare facilities were closed?

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* 4. How many adults with special needs or need additional care would you need to find substitute care for if support/care facilities were closed?

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* 5. How many older individuals would you have to find substitute care for if eldercare services were closed?

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* 6. Do you or anyone in your household have a chronic condition that affects their immune system?

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