All Things Disability

COVID-19 Response Santa Clara County AFN Communities

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This survey is a grassroots tool to collect experiences of members of the Access and Functional Needs Community on the COVID-19 response in Santa Clara County. This survey will take 6 to 10 minutes to complete. 

Disasters have a disporportionate impact on people with disabilities.  The term Access and Functional Needs was created to allow emergency response systems to create a Whole Community approach.

This process hopefully creates a preparedness, response, and recovery that does not leave people out of the solutions. Individuals with access and functional needs may include people with disabilities, children, older adults, persons with limited English proficiency, and persons with limited access to transportation.
 
If you have any questions, please reach out to Michele Mashburn at michele@sanjosepeace.org.
1.Are you a member of the Access and Functional Needs Community?(Required.)
2.Do you live in Santa Clara County?(Required.)
3.What city do you live in? If you do not live in Santa Clara County, please use the city where you work.(Required.)
4.Overall, how satisfied were you with Santa Clara County's COVID-19 Response?

Please rank your satisfaction on this scale of 5 to 1 with 5 being the very satisfied and 1 being very dissatisfied.(Required.)
5.Overall, how satisfied were you with your city's COVID-19 response?

Please rank your satisfaction on this scale of 5 to 1 with 5 being the very satisfied and 1 being very dissatisfied.(Required.)
Testing for COVID-19
6.Are you familiar with the testing sites in Santa Clara County?(Required.)
7.Have you been tested for COVID-19?(Required.)
8.Have you tested positive for COVID-19?(Required.)
9.If you have had COVID-19, did you use the County's Isolation and Quarantine Support Program?(Required.)
10.Even if you have not used them, do you feel testing sites are accessible?
11.Please share your thoughts and experiences about the testing sites.
Vaccinations
12.Are you familiar with the vaccination sites in Santa Clara County?
13.Have you received a COVID-19 vaccine?
14.Please share any thoughts you have about the vaccines.
Other thoughts.
15.Please share any positive experiences during the COVID-19 response.
16.Please share any negative experiences during the COVID-19 response.
Demographics
17.How old are you?
18.What is your race or ethnicity? (More than one option is allowed)
19.What is your gender? (More than one option is allowed.)
Please click done to save your responses. Thank you for your help.