Survey About Getting the COVID-19 Vaccine

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We need your help! The East Orange Department of Health and Human Services is doing a survey to determine how East Orange residents feel regarding a COVID-19 vaccine and to determine the information that the community might find most helpful as we prepare for vaccine dissemination. We hope to use this information to develop clear messages around the COVID-19 vaccination program and see what kind of information residents may need to feel comfortable getting it.

The survey should take about 5-7 minutes to complete. If you have any questions about the survey, you can e-mail Iman Johnson, Health Educator, at iman.johnson@eastorange-nj.gov or call 973-266-5492.

How old are you?

Under 18

18-24

25-34

35-44

45-54

55 and older

Clear selection

What is your race and/or ethnicity? (Check all that apply)

Black/African American

White

Asian/Pacific Islander

American Indian/Alaskan Native

Hispanic/Latinx

Other

Which ward do you live in?

Ward 1

Ward 2

Ward 3

Ward 4

Ward 5

I don't live in East Orange

Clear selection

What is your profession?

Healthcare Worker

First Responder (Fire Department, Police Department, EMS)

Other Essential Worker

East Orange Municipal Employee

EOSD Employee

Other:

Clear selection

Have you taken this survey before? (It's okay to take it more than once)

Yes

Clear selection

Do you believe you are at risk for COVID-19 because of a preexisting condition, your age, or your profession?

Yes

I'm not sure.

Clear selection

When a vaccine for COVID-19 becomes available, are you planning to get it? *

Yes

I'm not sure yet.

I've already gotten the vaccine.

Since first learning about the vaccine, what has changed your mind about getting it from a no to a yes? *

I've seen people I know get the vaccine.

I've spoken with and heard from health experts about the vaccine.

The COVID-19 Town Hall Meetings.

Learning more about the ingredients.

I haven't changed my mind and I am not getting it.

Other:

Required

If you don't plan to get the COVID-19 vaccine, why not?

The vaccine feels rushed.

I don't have enough information about the vaccine.

I don't trust a COVID-19 vaccine.

N/A, I will be getting the COVID-19 vaccine when it's available.

N/A, I have already received the COVID-19 vaccine.

Other:

Clear selection

What will help you make a decision to get the vaccine for COVID-19?

Getting more information about it (how long does it last, side effects, etc).

Seeing someone I know and/or respect get the vaccine.

I plan to get the vaccine, just not yet.

Nothing because I won't get it.

Other:

What questions do you have about the COVID-19 vaccine?

If you are interested in getting the vaccine, please leave your name and a way to get in contact with you (phone number and/or email address).

Submit

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