COVID-19 Vaccine Survey

Gathers employee or student opinions about the COVID-19 vaccine and their main concerns before deciding whether to get vaccinated.

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What is your employment status?

Employed full-time Employed part-time Unemployed Student Retired

Do you go to school?

Yes No

Do you go to the main office?

Yes No

Are you planning to get the COVID-19 vaccine?

Yes No Undecided

Which of the following describe your concerns about getting the vaccine?

Side effects Insufficient testing Allergic reaction Distrust of authorities No concerns

Which of the following would be helpful if you have not decided yet?

More information from a doctor Testimonials from others Scientific data Incentives

Please explain your reasons

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