Coronavirus Survey Form

Name

E-Mail

Age (optional)

Which consequence has upset you the most?

Loss of friends or family members
Loss of employment
Personal health
Cancellation of personal events (Marriages, funerals, birthdays etc.)
Cancellation of public events (Sports, concerts, museums, bars etc)
Other

Have you been infected with the Coronavirus?
Yes No Don't know

What measures do you take to protect yourself? (Check all that apply)

Staying at home
Wearing face masks
Using desinfectant
Keeping distance of 2 metres
Using protective goggles

What is your opinion about the current situation?
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