Covid19 Impact Survey
Health Equity Council

The following survey is designed to collect insight on your personal, agency, and community experiences navigating COVID19 in 2020 and moving into 2021. All answers are voluntary, and you may stop at any time. Your response is anonymous, and your name will not appear in the final write up. I will keep your responses confidential to the extent required by law (e.g.., reporting child abuse of a minor under age 18). Your response to the survey is your consent to participate. Your identity and the identity of your agency will be protected. If you have no issues being identified, please indicate in the initial response section. The survey collects demographic information (i.e., age, occupation, race, gender), however you are not obligated to provide this information if you do not feel comfortable. Your responses and your participation will be kept anonymous, and your participation will not be shared with your community. There are minimal risks associated with your participation in the survey.
We appreciate the time and energy and your responses will contribute to the city’ Long Term Recovery Plan. The following survey is broken into four sections.

Email *
Section I:
Individual, Agency, and Community Demographics
1. Do you wish to remain anonymous? *
1 point
2. Do you wish for your agency's name to be identified in the final write up? *
1 point
Required
3. Name:
4. Occupation:
5. Name of agency:
6. Mission of agency:
7. Type of agency
8. How many employees?
9. Agency location
10. Primary populations served:
11. Does your agency provide health insurance?
Clear selection
12. Do you have health insurance?
Clear selection
13. What type?
The Bernalillo County Community Health Council recognizes that unique social locations shape the experiences and agencies, agency management, and populations being served. Such unique locations may impact the ways that individuals, group, agency, and community navigated the inequalities experiences during the COVID19 pandemic.  
14. Racial and ethnic description of agency leadership:
15. Racial and ethnic description of staff(how many people of each race and ethnicity make up staff of agency)
16. Racial and ethnic description of community served
17. Gender of agency leadership
18. Gender of staff
19. Gender composition of community served
Section II:
Individual Experience Navigating COVID19
20. What were some of your personal experiences during COVID19?
21. Did you experience job loss, issues with housing, hospitalization?
22. Did you or anyone in your immediate network or family need medical attention during 2020? (Covid or non-Covid related?)
Clear selection
23. What was your experience like?
Section III:
Agency Experience Navigating COVID19
24. How has your agency been impacted by the pandemic?
25. What are some of the experiences your agency has had when it comes to providing services to the public?
26. What does your agency need to provide a full array of services?
27. Based on your agency's experience what are some of the local (city/county) policy solutions you recommend?
Section IV:
Community Experiences
28. What are some of your community's experiences navigating the pandemic?
29. What groups within your community were most affected? (i.e., women, undocumented)
Section V:
Visioning
30. What are three things that could have been in place before the pandemic that would have made this crisis less severe for communities?
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