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Please answer the following questions. During the PAST TWO WEEKS:

… have you been exposed to someone likely to have Coronavirus/COVID-19? (check all that apply)

Yes someone with positive test Yes someone with medical diagnosis but not test Yes someone with possible symptoms but no diagnosis by doctor Not to my knowledge

… have you been suspected of having Coronavirus/COVID-19 infection?

Yes has positive test Yes medical diagnosis but no test Yes have had some possible symptoms but no diagnosis by doctor No symptoms or signs

… have you had any of the following symptoms? (check all that apply)

Fever Cough Shortness of breadth Sore throat Fatigue Loss of taste of smell Eye infection Other

If you chose 'Other' please specify

… has anyone in your family been diagnosed with Coronavirus/COVID-19?(check all that apply)

Yes member of household Yes non-household member No

… have any of the following happened to your family members because of Coronavirus/COVID-19? (check all that apply)

Fallen ill physically Hospitalized Put into self-quranting with symptoms Put into self-qurantine without symptoms Lostor been laid off from job Reduced ability to earn money Passed away None of the above

During the PAST TWO WEEKS:

… how worried have you been about being infected?

Not at all Slightly Moderately Very Extremely

… how worried have you been about friends or family being infected?

Not at all Slightly Moderately Very Extremely

… how worried have you been about your physical health being influenced by Coronavirus/COVID-19?

Not at all Slightly Moderately Very Extremely

… how worried have you been about your Mental/Emotional health being influenced by Coronavirus/COVID-19?

Not at all Slightly Moderately Very Extremely

How much are you reading, or talking about Coronavirus/COVID-19?

Never Rarely Occasionally Often Most of the time

Has the Coronavirus/COVID-19 crisis in your area led to any positive changes in your life?

None Only a few Some

If answered "Only a few" or "Some" to question "Has the Coronavirus/COVID-19 crisis in your area led to any positive changes in your life?" please specify:

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