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* 1. Please select your age group.

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* 2. Select your county of residence.

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* 3. How many people live in your household?

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* 4. Are you or is anyone in your household vulnerable to serious complications if COVID-19 is contracted?

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* 5. If you normally work outside the home, how many workers are employed at your place of business?

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* 6. What industry are you employed in?

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* 7. Which of the following category about your work-from-home ability do you fit into?

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* 8. Has your household income been reduced due to COVID-19?

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* 9. Do you have adequate childcare to continue working?

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* 10. What are your most pressing concerns? Select all that apply.

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* 11. Are you capable of completing your job at home? Select the option most applicable to your job tasks. If you are currently not working, please answer N/A.

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* 12. How adequate are your technology devices for working remotely?

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* 13. How adequate are your modem capabilities for working remotely?

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* 14. Do you have adequate broadband connection for working remotely?

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* 15. How has working from home affected your productivity?

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* 16. Do you have a dedicated workspace in your home?

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* 17. How has communication between your coworkers changed, if at all?

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* 18. Are you eligible to file for unemployment?

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* 19. Have you filed for unemployment?

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* 20. Were you eligible to file for unemployment before the new COVID-19 relief bill made changes to unemployment insurance, or are you eligible based on those changes?

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* 21. If you have experienced reduced hours, what percentage decrease have you experienced? If you are currently not working or experienced no decrease, please answer N/A.

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* 22. If you have experienced increased hours, what percentage increase have you experienced? If you are currently not working or experienced no increase, please answer N/A.

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* 23. If going into work, how do you feel about the adequacy of precautions currently being taken by your employer to keep you safe? If you are not working or are currently working from home, please select N/A.

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* 24. How concerned are you about going to an onsite workplace?

  Not at all concerned. Somewhat concerned. Very concerned.
Contamination on office surfaces.
People breaking social distancing in the workplace.
Bringing the virus back to a high-risk person at home.

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* 25. If you are currently unemployed, how do you feel about going back to work?

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* 26. If you remain employed and are working from home, how do you feel about going back to the workplace?

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* 27. What do you need for your employer to provide in order for you to feel comfortable going to an onsite workplace? Select all that apply.

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