LTC Staff and Resident Vaccination Survey
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1.
What is the name of the Assisted Living Community you are doing business as?
(Required.)
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2.
Certification Number:
(Required.)
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3.
What Kentucky county is your facility located?
(Required.)
-All questions below will require a whole number as a response-
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4.
How many residents are in your facility?
(Required.)
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5.
Of those residents, how many have been fully vaccinated against Covid-19?
(Required.)
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6.
How many residents have only received the 1st dose?
(Required.)
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7.
How many staff are employed in your facility?
(Required.)
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8.
Of those staff members, how many have been fully vaccinated against Covid-19?
(Required.)
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9.
How many staff members have only received the 1st dose?
(Required.)