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City of Connellsville COVID-19 Survey
Thank you for taking the time to complete this survey. All of the information that you share will remain anonymous. The purpose of this survey is solely to gauge the impact of COVID-19 in our city. Please keep in mind that this survey is household-based, only one survey should be completed for each household - regardless of how many adults or family members live in the house. If you have any questions please contact Vernon Ohler at 724.628.2020 ext. 200.
In what ward do you reside?
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How many people live in your household?
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Do you have children under the age of 18 in your household?
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Yes
No
If you answered yes, please tell us how many:
Do you have people over the age of 65 in your household?
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Yes
No
If you answered yes, please tell us how many:
Do you have a member of the household who falls into high-risk, vulnerable populations as defined by the CDC?
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Yes
No
You can find more information about high-risk vulnerable groups here:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html
Has your household lost income due to COVID-19?
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Yes
No
Has anyone in your household become unemployed due to COVID-19?
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Yes
No
If you feel comfortable answering, how much income has been lost due to unemployment, hour reduction, or business closure?
Please try to gauge what your current monthly income is compared to what it was before. For example, if your household was earning $2,200 per month, but now earning $1,000; please enter $1,200.
Is anyone in your household a small business owner who has been impacted by COVID-19?
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Yes
No
In what fields do/did people in your household work?
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Has anyone in your household applied for unemployment?
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Yes
No
Has anyone in your household who has signed-up for unemployment begun receiving payments?
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Yes
No
Not applicable
If multiple people in your household have applied for unemployment, but some have received compensation and others have not - please share how many have signed up and how many have NOT received compensation yet.
Has anyone in your household lost their health insurance as a result of job loss or hour reduction due to COVID-19?
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Yes
No
Is anyone in your home a medical professional or first responder?
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Yes
No
For example: Doctor, Nurse, Physicians Assistant, Respiratory Therapist, Nursing Assistant, Fireman, Police Officer, EMT, etc.
Is anyone in your household working remotely?
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Yes
No
Is anyone in your household an essential employee who still has to go to work everyday?
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Yes
No
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