In what country do you currently reside?
United States
Other
How old are you?
18-24
25-34
35-44
45-54
55-64
65+
What is your gender?
Female
Male
Non-binary
Prefer not to say
Please specify your level of educational attainment (if currently in school, please select for which degree):
No formal education
High school diploma
College degree
Vocational training
Master’s degree
Professional degree
Doctorate degree
Which of the following categories best describes your employment status during COVID-19?
Student
Employed, working full-time
Employed, working part-time
Furloughed (temporary lay-off)
Not employed, looking for work
Not employed, not looking for work
Retired
Disabled, not able to work
Which of the following best describes your current/most recent occupation?
Management Occupations
Business and Financial Operations Occupations
Computer and Mathematical Occupations
Architecture and Engineering Occupations
Life, Physical, and Social Science Occupations
Community and Social Service Occupations
Legal Occupations
Education, Training, and Library Occupations
Arts, Design, Entertainment, Sports, and Media Occupations
Healthcare Practitioners and Technical Occupations
Healthcare Support Occupations
Protective Service Occupations
Food Preparation and Serving Related Occupations
Building and Grounds Cleaning and Maintenance Occupations
Personal Care and Service Occupations
Sales and Related Occupations
Office and Administrative Support Occupations
Farming, Fishing, and Forestry Occupations
Construction and Extraction Occupations
Installation, Maintenance, and Repair Occupations
Production Occupations
Transportation and Materials Moving Occupations
If you are currently working from home, for how many hours a day?
Less than 5 hours
5 to 8 hours
More than 8 hours
Not applicable
Prior to working from home, how many hours did you work in a day?
Less than 5 hours
5 to 8 hours
More than 8 hours
Not applicable
Which of the following best describes your primary source on news related to the pandemic?
Social media (facebook, instagram, twitter)
Web news (CNN, NY Times, Wall Street Journal, Fox, etc.)
Television news
Which of the following best describes your quarantine living situation?
Remaining in place; living with family
Remaining in place; living with roommates
Remaining in place; living on one’s own
Relocated (in state or in country)
Relocated (out of state or out of country)
Have you at any point wondered whether you were presenting symptoms for COVID-19?
Yes
No
Rate the following: If I were to present symptoms for COVID-19, I am confident I know exactly where and how to get tested.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Which of the following describe concerns you are facing during the COVID-19 pandemic? Select all that apply.
Contracting COVID-19
Getting adequate exercise/movement
Mental health and wellbeing
Job security
Social isolation
Covering living expenses
Caring for children while working
The education of my child/children
Being quarantined with my partner/family member
The social dynamics/conflict within my home
Before visiting the COVID-19 TFDV website, which of the following had you considered to be major public health concerns during the pandemic? Select all that apply.
Testing availability
Hospital space
Interrupted education
Increased conflict within the home
Economic impact of lockdown
Domestic violence
Effects on mental health
Effects on physical activity
Personal protective equipment (masks, gloves, etc.) availability
During the current COVID-19 pandemic, do you know someone who is living in or returning to an abusive home?
Yes
No
Rate the following: If I were part of an unsafe or abusive home environment, I am confident I would be able to receive the support I need during this time.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
If the necessary infrastructure existed, through which of the following methods do you think a person would be most likely to safely and privately report an unsafe or abusive home environment? Select all that apply.
Phone call to 911 (or your country's emergency number)
Text message to 911 (or your country's emergency number)
At a health service provider (hospital, testing center)
Through shelter/resource/hotline
At a local pharmacy/market/grocer/bodega
Other