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Gender
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Male
Female
Other
Age
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18-24
25-34
35-44
45-54
55-64
65+
Ethnicity
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White
Mixed/Multiple ethnic groups
Asian/Asian British
Black/African/Caribbean/Black British
Other ethnic group
Region
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Scotland
Northern Ireland
Wales
North East
North West
Yorkshire and the Humber
West Midlands
East Midlands
South West
South East
East of England
Greater London
Housing
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Homeless
Staying with friends
At threat of eviction/repossession
Living in stable but Poor quality housing
Decent stable living conditions
Living arrangement
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Live alone
Single adult with dependents
You live with someone who you need and depend on for your care
Live in shared accommodation with other adults or friends
Live with family, spouse or partner
Employer
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General Public
Ambulance Service
Resilience Hub
Public Health England
Policing and Fire Service
CNTW Foundation NHS Trust
TEWV NHS Foundation Trust
Care Home Staff
Northumbria University
GP Surgery
Northumbria healthcare NHS Foundation Trust
Newcastle Upon Tyne Hospitals NHS Foundation Trust
North Cumbria University Hospitals NHS Trust
South Tyneside & Sunderland NHS Foundation Trust
North Tees & Hartlepool Hospitals NHS Foundation Trust
South Tees Hospitals NHS Foundation Trust
County Durham and Darlington NHS Foundation Trust
Gateshead Health NHS Foundation Trust
Other
Other NHS Trust (Not Listed)
Community Pharmacy
(If you were not reffered by your organization select general public)
Occupation
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Prefer not to say
Administrator
Reception
Nurse
Doctor
Midwife
Dietitian
Dentist
Police & Law Enforcement
Fire & Rescue
Local Goverment
Manager
Corporate
Care Support Worker
Counselling and Therapy
Community Pharmacy Team
Student
Researcher
Lecturer
Retail
Caregiver
Teachers
Students
Primary Care
Health Visitor
District Nurse
Community Pharmacist
Other key worker staff (Shop workers, Delivery drivers)
Social Workers
Other (Specify when prompt)
(Select your occupation or specify other)
Occupation
(Specify your occupation)
Have you had covid 19?
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No
Not sure
Yes but no symptoms
Yes but few symptoms
Yes badly but managed at home
Required some hospital attention
Intensive care in hospital
Prefer not to say
(Only if you have a confirmed positive test)
On average how many hours a week do you work?
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0-10
10-20
20-30
30-40
40-50
50-60
Email
(used to login and for notifications, not to ID you)
Password
(at least 8 characters)
Confirm Password
(at least 8 characters)
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(We may contact you for feedback or to participate in using other tools)
I agree to the personal information policy below
Personal information policy
Any personal information collected is kept strictly confidential, held securely and anonymised.
System admins will be able to view your scores in a statistical summary and will not have access to view your individual scores.
You will be able to view your personal information and any data entries on the system.
You will be able to withdraw at any point and delete any data related to your record on the system.
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