Zimbabwe COVID-19 Underlining Condition Population Tracing
In the fight against COVID-19 worldwide, there is an urgent effort to identify vulnerable communities. We are working towards the development of a Zimbabwean Underlying Conditions Population Segmentation (UPCS) to enable the identification of those most at risk of succumbing to COVID 19. This is so that we can have a targeted rapid response approach in place to assist the most vulnerable in Zimbabwe. By completing this form for yourself and loved ones you are playing a part in the fight against COVID-19 and potentially saving a life.  If you share your contact details, you can become a nerd node of trust and provide accurate information for those in your network.

You can complete multiple forms if need be.
Sign in to Google to save your progress. Learn more
DO you or any of your relatives in Zimbabwe have any of these risk factors? *
Required
Were you aware of these COVID-19 Risk Factors are? *
Which Province is the person with the risk factors above located?
Which City or Village?
House Number and Street Name
If Village, provide name of Sabuku or Chief plus any details that might help is locating your loved ones.
Please provide your phone number so we can timely reach you, should there be need. This will also enable us to  share any useful aid information or any other useful information via text or WhattsApp *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms