Covid-19 Vaccine Survey
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Have you received the COVID-19 vaccine? *
If you haven’t gotten the vaccine, are you interested in receiving it?
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Which statement best describes how you feel about getting the COVID-19 Vaccine? *
If you answered “I will probably NOT get it” or “I will definitely NOT get it”, what best describes the reason why? *
If you answered "Something else or N/A" in the last question can you please let us know why.
Have you or someone you know gotten COVID-19 *
Are you still generally concerned or worried about COVID-19 pandemic? *
Did you already receive a flu shot or do you plan to get the flu shot this flu season? *
Do you usually wear a mask or face covering when in public? *
7. Do you usually stay at home when you feel sick? *
Which best describes your gender?
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What is your age group? *
What is your race/ethnicity?
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What is your zip code? *
Please choose the best employment type that fits your current situation: *
Required
*You are an “Essential” worker if you had to continue in-person job activities during the Mayor’s Stay at Home Order
Thank you for completing the Covid-19 Vaccine Survey.
Remember, ways to protect you and others from COVID-19 include: Practice social distancing, Wear a mask or face covering, Wash your hands, Stay home if you feel sick, Choose your activities wisely. For more information, please go to: www.epstrong.org
• Observe County and City’s Stay Home Orders
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