Relative 1 Relative 2 Relative 3

Personal information Answer

1 Name of Person
2 Age
3 Sex
Knowledge of Disease Answer

4
To the best of your knowledge, the novel
Coronavirus is
The Coronavirus is typically spread (i.e.,
5 passed from person-to-person) by which
means?
6 Coronavirus can be prevented by
7
The most important symptoms of COVID19
/ Coronavirus are
8 Have you ever infected with Covid-19?
9 What symptoms you observe?
10 Is covid-10 age-specific ?

11 Is covid-10 tissue-specific / Organ specific ?

are appropriate /specific treatements available

12
for Covid-10?

13 How many time period it takes to recover?

Precautionary Behavioral (Preventive measures) - Yes/No

14 I avoid going to public places
15
I frequently use hand sanitizer after
shaking someone’s hand

16
I want people’s temperature to be taken
before they enter public places

17
It really bothers me when people sneeze
without covering their mouths

18
I dislike wearing face mask because it looks
somehow

19
I avoid touching door handles and stair
case railing at public locations

20
How soon do you expect the Coronavirus
holiday to end /things to return to normal?
 Relative 4 Relative 5

wer

wer

/No