First Name

Last Name


What is your gender?


Name of hospital or healthcare facility you work in

Have there been any known or suspected COVID-19 virus cases in the facility you work in?

Is your facility equipped to handle cases of COVID-19?

Rate your facility in the following aspects

  Extremely Poor Poor Moderate Good Extremely good
Availability of doctors
Availability of nurses
Availability of beds
Training of healthcare professionals
Safety measures taken

Have you been given training to handle known or suspected cases of COVID-19?

Do you feel prepared to care for patients with COVID-19?

Have you personally dealt with a known or suspected COVID-19 patient?

Has your facility done enough to ensure your safety?

Have you been instructed on what to do if you feel you've been exposed to a known or suspected COVID-19 patient?

Do you feel safe at work?

Has your facility offered you additional compensation or benefits during the duration of the COVID-19 epidemic?