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Name *

Please do not include my name when sharing my comments.

Phone number (include area code, please) *

City *

Email address

Are you still working during the Coronavirus crisis?

I'm still working.

I've been sent home with pay.

I've been laid off.

I was already not working before the crisis.

Other:

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Are you (or is somebody close to you) an essential worker? *

I am an essential worker.

One of my loved ones is an essential worker.

I don't know.

Other:

What kind of work do you/your loved one do?

Do you/your loved one have to leave the house in order to go to work?

I my loved one has to leave the house to go to work.

I/my loved one is able to work from home.

I/my loved one sometimes works from home and sometimes goes into a job site for work.

Other:

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Do you/your loved one have access to any paid sick time or paid leave to deal with illness or caregiving responsibilities related to the Coronavirus outbreak?

I/my loved one already had paid sick time or paid leave through my/their job.

I/my loved one did not have have paid sick time/paid leave before the crisis, but I/they now have emergency paid sick days and paid leave.

I don't have paid sick time or paid leave.

I don't know.

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Do you have any concerns for your/your loved one's health and safety going in to work at this time? How do you feel about your/their health and safety?

Are you or a loved one providing care for other family members or friends?

I/my loved one is caring for elderly or other high-risk relatives.

I/my loved one is caring for children whose school/daycare has shut down.

I/my loved one is caring for friends and neighbors who are elderly or otherwise high-risk.

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Do you feel you/your loved one is able to protect the health and safety of the other people you/they live with or are caretaking for while working? Please share your thoughts.

What do you want people to know about your/your loved one's experience working during this pandemic?

Anything else you want to share?

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