Pine Ridge Community Needs Survey
As a community, we need to prepare for COVID-19. In partnership with OST, we are asking for your help in understanding the situation and needs on Pine Ridge so that we can powerfully take on this pandemic here at home. The information you provide will be aggregated and used to inform our overall response plans.

Please fill out only one survey per household. Thank you for participating and helping our community be stronger.
What district do you live in?
Clear selection
How many people in your household are Hokšíčala/Wakȟáŋyeža (0-12 years old)?
How many people in your household are Hokšíla/Wičhíŋčala (13-21 years old)?
How many people in your household are Kȟoškálaka/Wikȟóškalaka (22-38 years old)?
How many people in your household are Wičháša/Wíŋyaŋ (39-54 years old)?
How many people in your household are Wičháȟčala/Winúȟčala (55+ years old)?
What health conditions or lifestyle habits are present in members of your household?
Is anyone in your household currently experiencing fever, dry cough and/or shortness of breath?
Clear selection
How much food, on average, do you have in your home?
Clear selection
Do you have reliable transportation to and from your home?
Clear selection
What is the best way to get needed supplies to your household safely?
Clear selection
If you suspected you had COVID-19, where would you most likely seek treatment / help?
Clear selection
What supplies and/or treatments do you currently have in the home?
Can we contact you about our efforts and services around COVID-19? If so, please provide your name and contact information below (phone number and/or email).
Are you aware of a household that may be unable to fill out this survey that we should connect with? If so, please provide contact information below.
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