CovidNet.org : "Self-questionnaire because Your opinions on your life and living are precious ! "

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We are living together a new situation and your personal feedback is precious for everybody.

What are you living today and what are your feelings about it? (NONE OF THE QUESTIONS ARE MANDATORY / WORKING DOCUMENT / BETA VERSION)

Cliquez ici, svp, si vous parlez français : https://forms.gle/fu5XpywvVmQxtz8i8
Klicken Sie bitte hier, wenn Sie Deutsch sprechen : https://forms.gle/5MrAnd6fFz6u6Vms7

I join the fight against the spreading of the virus in the following ways (multiple answers are possible) :

I wash my hands regularly;

I keep a distance to others;

I telework (work from home);

I study at distance;

I only move outside by necessity;

I care for a person sick with the virus;

Other:

At the moment, with the situation in mind, I feel :

I have at my dosposal :

Relatives who can help me

Relatives I can help

Food and essential goods

Paracetamol

A thermometer

An oximeter (on smartphone)

A guide describing symptoms to observe

Other:

I believe I have :

Not been touched by the virus

Somatized (imagined) the symptoms without haven been touched by the virus.

Been in contact with a sick person

The virus enduced sickness but in a lenient form

The virus and should observe the situation

Have healed

Other:

Clear selection

I wish to improve the experience of being confined by increasingly consulting :

Information about how to auto-evaluate my symptoms

Programmes adapted to children’s school programmes

Clear behaviour guides

Health programmes for 18-30 year olds

Health programmes for over 60 year olds

Other:

I would like to send you the following information which seems to me to be fake news which could have repercussions on our health :

I would like to inform you that I am :

More or less 20 years old

About 60 or older

Clear selection

I am confined :

alone

with my partner

with one or more children

with one or more cats

with one or more dogs

Other:

I share my confinement with other people and for the moment I think our relationships are :

Very difficult

Excellent

Clear selection

I believe it would be useful if you knew that I reside in :

Australia

Canada

England

Iceland

Ireland

New Zealand

Switzerland

United States

Other:

Clear selection

I would be interested to pursue the monitoring of my feelings by re-completing this auto-survey during my confinement :

I have comments and/or improvements to suggest

Notes :

Information you have transmitted are anonymous and stay at the disposal of the different stakeholders of this non-commercial pilot study.

Important : We have launched this prototype study as a result of medical studies published by The Lancet in order to prevent confinement induced effects on parts of the population. The persons distributing this survey have verified that it repsects the laws and ethics of the country where it will be used. The authors cannot be held responsible.
Minors (young people) cannot transmit their information.

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