Survey About Getting the COVID-19 Vaccine
We need your help! The East Orange Department of Health and Human Services is doing a survey to determine how East Orange residents feel regarding a COVID-19 vaccine and to determine the information that the community might find most helpful as we prepare for vaccine dissemination. We hope to use this information to develop clear messages around the COVID-19 vaccination program and see what kind of information residents may need to feel comfortable getting it.

The survey should take about 5-7 minutes to complete. If you have any questions about the survey, you can e-mail Iman Johnson, Health Educator, at or call 973-266-5492.
How old are you?
Clear selection
What is your race and/or ethnicity? (Check all that apply)
Which ward do you live in?
Clear selection
What is your profession?
Clear selection
Do you believe you are at risk for COVID-19 because of a preexisting condition, your age, or your profession?
Clear selection
When a vaccine for COVID-19 becomes available, are you planning to get it?
Clear selection
If no, why not?
Clear selection
What will help you make a decision to get the vaccine for COVID-19?
What questions do you have about the COVID-19 vaccine?
If you are interested in getting the vaccine, please leave your name and a way to get in contact with you (phone number and/or email address).
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