COVID-19 IMPACT QUESTIONNAIRE We are living in a historic moment. In the same way that, today, we want to know how people have experienced daily life, communicated, and worked together years from now, others will want to know how we navigated the experience of a global pandemic brought on by Covid-19 (SARS-CoV-2). In an effort to document this moment in history, this public special collections wants to collect and preserve the experiences and reactions of citizens across many countries.PERSONAL IMPACTHow has your daily life been impacted by the Covid-19 pandemic?Are you wearing face masks? Do you watch your distance 6 feet apart and wash hands for at least 20 seconds? Do you have other personal routines or outreach?How was your schedule and/or job impacted by the Covid-19 pandemic? How did your support respond to social distancing?When and how have you prepared for the pandemic?How have people around you responded to the pandemic?What are your biggest concerns right now? What activities did your children participate in during January 2020 to 2021?Do you know anyone who has or has had COVID-19? What was their experience with testing? With quarantine? If hospitalized, updates from medical facility?How have your interactions with others changed under social distancing?Are you working during social distancing? Are you trying anything new to contact others?Do you have children in school? How has the pandemic impacted them?Are you taking training and/or college courses? Where? And how has the pandemic impacted them?Do you have neighbors or family living nearby? How has the pandemic impacted your interactions with them? Do they provide support?If you have to leave the house for necessary trips, what precautions do you take? Where are you going? Do you patronize local?What news sources are you following? Do you get news primarily through television, print, or online?If you could offer advice to someone in the future about this time, what would it be?What is your age?Is there anything else about your personal experience you would like us to know?COMMUNITY IMPACTIn what ways has your community come together during the Covid-19 crisis? Are there ways it has not?How do you feel about the Covid-19 protocols, symptoms, medicines, and vaccine? What about the state and national government?Has the pandemic impacted how you value people working in the service industries that continued to function during the shelter-in-place order?Has the pandemic affected any projects and/or events you intended to attend or participate in? How? Is there a sense of urgency to continue?Is there an individual or service/public service including police, you feel went above and beyond during the Covid-19 crisis? How? What are you for charitable organizations?Have you noticed any local businesses getting creative with their services? How?MEDIA COLLECTION Upload images, videos, and/or audio that show what society is like under the Covid-19 pandemic. Please limit the size of each file to 10MB or less. Media CollectionMax. file size: 100 MB.Media CollectionMax. file size: 100 MB.Media CollectionMax. file size: 100 MB.Media CollectionMax. file size: 100 MB.Media CollectionMax. file size: 100 MB.DONATION STATEMENT & ANONYMITY OPTION Thank you for sharing your experiences! Your answers will be kept as a record of the pandemic in the Special Collections Archive. To finish up, please tell us a little bit about yourself. This portion of the survey is completely private and for office use only. Name(Required) First Last Permanent Street Address(Required) Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number(Required)Email(Required) Transfer of Ownership and Transfer of Copyright - I understand that upon agreeing to this Deed of Gift, the survey answers I provided become the legal property of Tech Daily Life/Tech Innovation Global Incorporated (Special Collections). We do not own trademarks or any other associated medical information (HIPPA) or your symbols used in commerce. Medical information is confidential to the patient. Access to the Collections - I understand that researcher access to the materials is governed by departmental policies and procedures, including: Materials held by Special Collections are held in secure storage and are used in the department or owned and operated digital platforms Materials will be open for research use and may be used in physical and digital exhibits, and may be reproduced, digitized, and reformatted for preservation and access Materials may be reproduced, in limited quantities, and provided to researchers for future reference Sensitive materials I identify at the time of donation, or that are discovered by Special Collections Staff during processing, may be restricted to protect my/our privacy or others for a limited and clearly stated period of time.Transfer Terms and Conditions(Required) I understand and agree to the terms and conditions described above.By participating in this survey, I acknowledge that I have willingly agreed to participate by sharing personal/family stories and their meaning. I understand and agree that the information I provide, as well as the digital copies of artifacts and stories, and any derivative products, will become the property of Special Collections and may be used by Special Collections for research, teaching, and other educational purposes, as well as for publication and other means of dissemination. I understand that I will receive no remuneration or compensation for the information or artifacts I provide. I release the Information Collector, Special Collections, and all affiliated people and institutions, from any and all claims for damages for libel, slander, invasion of privacy, or any other claim based on the use of the information and materials provided. I understand participation is voluntary. I understand that I can withdraw from the project at any time. Survey Terms and Conditions(Required) I understand and agree to the terms and conditions described above.Anonymous Submission I wish to remain anonymous, should these survey answers be used for future research, exhibits, etc.NameThis field is for validation purposes and should be left unchanged.
