Question

Make your own survey on a health administration or public health topic of your choice.

Create a survey with 10 questions that adheres to the following requirements:

• Descriptive Name
• Flow of questions is thoughtful and makes sense
• Minimum of 2 sections
• Question types (other questions types are up to you)
  • 1 drop down question with 5 options
  • 2 multiple choice questions (minimum of 3 options)
  • 1 "check all that apply" question
  • 1 multiple choice grid question with a minimum of 3 column/rows
  • 5 other types of questions
  • Make 5 questions mandatory (required)

Answer 1

Survey On Impact Of COVID 19 On Mental Health Issues

Name: ________________ SSN: ______________

Section A

Impact on self

1. How would you assess your mental status during COVID 19 compared to that before it? [Mandatory]

(a)Panicky (b)Stressful (c)Same as before

2. What do you think could be the reason that contributed the most to your present mental issues? [Mandatory]

(choose from the drop-down list)

· Isolation

· Fear of disease/death of self

· Fear of disease/death of family members

· Financial

· Attitude of family members

3. Did you experience any of the below given [Mandatory]

(check all that apply)

a) Shock from the death of a near/dear one

b) Helplessness

c) Hopelessness

d) Depression/anxiety

e) All of the above

4. Where you stressed from financial hardship due to unemployment?

(Choose Yes or No)

a) Yes

b) No

5. How did you address unemployment issues if you had any? (write 4-5 sentences) [Mandatory]

Section B

Impact on Family

6. Give details of your family members and their mental status during COVID 19 in the grid.[Mandatory]

(put Yes or No)

Family member name	Same as before	Less interactive and gloomy	More interactive and cheerful
X
Y
Z

7. Describe a bad experience that you want to forget from a family member during COVID 19?

8. Describe a good unforgettable experience you had from a family member during COVID 19?

9. How would you rate your family members' attitude during COVID 19 on a scale of 1 to 10 with one being really good and 10 being the worst?

10. How did it affect your mental status? (choose the correct answer)

a) Changed my attitude towards life

b) Did not have any impact

c) Had only slight impact.