QUESTIONNAIRE

INTRODUCTORY TEXT

This survey aims to understand how healthcare professionals feel regarding their preparedness to deliver infection
prevention and control (IPC) procedures in healthcare settings during the COVID-19 pandemic.

The information we collect will help improve preparedness to prevent healthcare workers becoming ill
and to effectively prevent spread of COVID-19. In this survey, we refer to infection prevention and
control procedures that should be adopted when managing patients with suspected or confirmed COVID-
19.

If you are willing to take part in this study, please confirm the following: yes/ no
• I understand that my participation is completely voluntary
• I would like to take part in this study

DEMOGRAPHIC TEXT

AGE/GENDER
PROFESSION
DO YOU PROVIDE DIRECT CARE TO
PATIENTS
Number of children living in the home, if any,
under the age of 17yrs
Do you have caring responsibilities for any adults,
including those with disabilities or those over the
age of 70 years?

Source of Information About Novel Corona Virus (COVID-19)

A. News Media
B. Social Media
C. Official Government website
D. Family and Friends
E. Training by the hospital management, WHO, MoPH

Health Worker’s Knowledge about COVID 19

Questions Yes No
1. Novel coronavirus (COVID-19) is thought to be originated from
bats
2. COVID-19 is transmitted through air, contact, faecal-oral routes
3. Headache, fever, cough, sore throat, and flu are symptoms of
COVID-19
4. The incubation period of COVID-19 (2-14 days)
 5. COVID-19 leads to pneumonia, respiratory failure, and death
6. Supportive care is the current treatment for COVID-19
7. Hand washing, covering nose and mouth while coughing, and
maintaining physical distance from sick people can help in the
prevention of COVID-19 transmission.

Perception of Healthcare workers’ towards COVID-19

Questions Yes No
8. COVID-19 symptoms appear in 2-14 days

9. COVID-19 is fatal
10. Flu vaccinated is sufficient for preventing COVID-19
11. During the outbreak, eating well-cooked and safely handled
meat is safe
12. Sick patients should share their recent travel history with
healthcare providers
13. Disinfect equipment’s and working area in wet markets at least
once a day
14. Washing hands with soap and water can help in prevention of
COVID-19 transmission

What are exist of the following at the screening facility?

Items Screening Facility

Yes No
15. Screening Tents/Facilities
16. Hand wash with water facility
17. Hand wash solution/Soap
18.Sanitiser
19. Toilet
20. People use masks or other
clothes to cover their face
(nose/mouth)
21. Availability of functional Infra-
red Thermometer

As a health care worker, how I avoid the risk of catching COVID-19 while screening and
assessing the patients?
Items Yes No
22. Gloves
 23. Surgical face mask
24. Disposable, fluid resistant gown
25. Eye protection
26. Regular hand hygiene
27. N 95 Face mask

28. Do you feel that the PPE available to you is adequate to protect you when managing
patients with COVID-19 Available is defined as recommended + in stock can be used
by the respondent?

A. Not confident at all

B. A little confident
C. Somewhat confident
D. Confident
E. Very confident