NMEMC COVID-19 Questionnaire
The North Mecklenburg Economic Mobility Collaborative is concerned about how people are coping during the COVID-19 pandemic, as a result of its impact on jobs, services and what people can and can't do. We'd like to hear from you. And we'd like to be able to connect you with help you might need. You can call 211 for help, or you can visit the COVID-19 resource page on our website:
www.northmeckEMC.org/COVID
for a list of links to resources.
How, if at all, has COVID-19 affected you and your immediate family? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
Someone in the household lost their job
Someone in the household lost hours at their job
Daycare is no longer available
We can't pay our rent or mortgage
We don't have enough food
We are feeling lonely because we can't spend time with friends and family
We are getting on each other's nerves
Someone in the household has gotten sick with the virus
Someone in the household has passed away
Other:
How, if at all, has COVID-19 affected people outside of your family that you are close to, such as neighbors or extended family members? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
Someone in the household lost their job
Someone in the household lost hours at their job
Daycare is no longer available
They can't pay their rent or mortgage
They don't have enough food
They are feeling lonely because they can't spend time with friends and family
They are getting on each other's nerves
Someone in the household has gotten sick with the virus
Someone in the household has passed away
Other:
What are your biggest worries for the next month? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
Not having enough food
Not being able to pay my bills
That my children will fall behind academically because it’s difficult to help them at home
Getting sick or dying from the virus
Not being able to get the healthcare I need
Losing my job or losing hours
Running out of toilet paper
Running out of the medicine I need
Feeling unsafe in my home
Other:
Have you been wearing a mask when you go to the store or are near people outside your household?
Yes, always
No, never
Sometimes
Clear selection
Do you have a mask to wear when you go out?
Yes
No
Clear selection
Do you need more masks for other family members?
Yes
No
Maybe
Clear selection
We've been told to stay 6 feet apart from everyone who doesn't live in our household. Please select the one answer that best describes whether people in your neighborhood are doing that.
Everyone is doing that.
Most people are doing that.
About half of the people are doing that.
Most people are NOT doing that.
Nobody is doing that.
Clear selection
If at least some people in your neighborhood are not staying 6 feet apart, why do you think they aren't doing that?
Your answer
How are you feeling emotionally? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
Worried/scared
Stressed/anxious
Blessed
Hopeful
Depressed
Angry
Frustrated
Relaxed
Other:
What brings a smile to your face or helps you get through this challenging time?
Your answer
If you would like someone to follow up with you, please provide your name and phone number or email address.
Your answer
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