1. Gender: |
male / female / other |
2. Age: |
___ |
3. Who lives in your household? |
spouse / parents / children / siblings / flat mate / alone / other |
4. In which hospital do you work? |
Ein Kerem / Mount Scopus / other |
5. What is your position in the hospital? |
senior doctor / resident / nursing staff / intern / lab worker / clerical staff / general services / technician / physical or occupational therapist / dietician / national service volunteer / nurse aid / volunteer / social worker or psychologist / other |
6. In what department do you work? |
______________________ |
7. Are you on a COVID-19 Department team? |
yes / no / other |
8. Are you currently working? |
working in the hospital / COVID-19 home isolation / at home for other reason (maternity leave, other illness, on work leave without pay ect.) |
9. The following are risk factors for COVID-19. Do you suffer from any of them? |
diabetes / obesity / hypertension / chronic heart disease / chronic lung disease / smoker |
10. Have you been in isolation because of the COVID-19? |
yes / no |
11. Have you have been tested for COVID-19? |
yes / no |
12. What were the COVID-19 test result? |
positive /negative / results not received |
13. Did you feel relieved after getting tested? |
yes / maybe / no |
13. Of all of the following, which is of the most concern? |
getting COVID-19 / infecting family / giving corona to patients / my children are at home when I am in hospital / financial problems / professional burnout / other |
14. Of the following, which would make the corona epidemic easier for you? |
better protective gear / educational solution for my children / psychological support / group support / financial help / other |
15. What percentage do you estimate that you already have gotten the corona virus? |
______% |