We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

COVID-19 Well-Being Survey

Tell us how COVID-19 has impacted you!

In these difficult times, you can do something important for your families, friends, neighbours, and community. The information gathered will help us understand and respond to our community's needs.

Please take 5 minutes to complete this survey by June 25, 2021.

Personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act and will be used to manage and deliver FCSS related community programs and services. If you have questions regarding the collection, use or disclosure of this information contact the Town of Vermilion FCSS at 780.581.2413 or the County of Vermilion River at 780.846.2244.

1. How would you say your mental health and personal well-being has changed due to the COVID-19 pandemic?

2. How concerned are you about the following impacts of the COVID-19 pandemic?

Space Cell	Extremely concerned	Very concerned	Somewhat concerned	Not concerned
My own mental health	My own mental health: Extremely concerned	My own mental health: Very concerned	My own mental health: Somewhat concerned	My own mental health: Not concerned
Family member's mental health	Family member's mental health: Extremely concerned	Family member's mental health: Very concerned	Family member's mental health: Somewhat concerned	Family member's mental health: Not concerned
Turning to substances to cope	Turning to substances to cope: Extremely concerned	Turning to substances to cope: Very concerned	Turning to substances to cope: Somewhat concerned	Turning to substances to cope: Not concerned
Family stress from confinement	Family stress from confinement: Extremely concerned	Family stress from confinement: Very concerned	Family stress from confinement: Somewhat concerned	Family stress from confinement: Not concerned
Increase in disagreements and conflict in my home	Increase in disagreements and conflict in my home: Extremely concerned	Increase in disagreements and conflict in my home: Very concerned	Increase in disagreements and conflict in my home: Somewhat concerned	Increase in disagreements and conflict in my home: Not concerned
Violence in my home	Violence in my home: Extremely concerned	Violence in my home: Very concerned	Violence in my home: Somewhat concerned	Violence in my home: Not concerned
Accessing the essential goods and items that I need	Accessing the essential goods and items that I need: Extremely concerned	Accessing the essential goods and items that I need: Very concerned	Accessing the essential goods and items that I need: Somewhat concerned	Accessing the essential goods and items that I need: Not concerned
Lack of access to services and programs	Lack of access to services and programs: Extremely concerned	Lack of access to services and programs: Very concerned	Lack of access to services and programs: Somewhat concerned	Lack of access to services and programs: Not concerned
Uncertainty about the future	Uncertainty about the future: Extremely concerned	Uncertainty about the future: Very concerned	Uncertainty about the future: Somewhat concerned	Uncertainty about the future: Not concerned
Loss of social connection	Loss of social connection: Extremely concerned	Loss of social connection: Very concerned	Loss of social connection: Somewhat concerned	Loss of social connection: Not concerned

3. Thinking about the current situation, have you experienced any of the following? (Check all that apply)

4. In times of stress and need, who do you turn to for help and support? Please choose your top 3.

5. Are you aware of the mental health and personal well-being resources in your community?

6. Have you or anyone in your household lost their job or experienced job instability because of the COVID-19 pandemic? (Check all that apply)

Yes, I have
Yes, someone in my household
No, but my hours have been reduced
No, my job/family income has not changed

7. Since the beginning of the COVID-19 pandemic, how has it been for you or your household to meet its financial needs?

8. My age:

9. How would you describe your gender?

Please enter an 'other' value for this selection.

10. Which of the following best describes where you live?

11. How do you find out information regarding services, programs and events? (Check all that apply)

Village, Town or County Website
Newspaper
Radio
Social Media
Word of mouth
Billboards, signs and posters
If other, please specify: Please enter an 'other' value for this selection.

12. Please provide any other feedback or comments:

13. If you would like to be entered for our prize draw for completing the COVID-19 Well-Being Survey, please enter your name and phone number.

	Name
	Phone Number