Respondent’s Details:

Name:________________________
(optional)

Year level: ____________________

Course : ______________________

Gender:_______

Age:______

Did you get your first dose/Are you fully vaccinated?

o YES

o NO

What is the vaccine that you received?

o MODERNA

o PFIZER

o J and J

o SINOVAC

o SINOFARM

o ASTRAZENICA

o SPUTNIK V
Stongly Disagree (5) Disagree (4) Neutral (3) Agree (2) Strongly Disagree (1)

5 4 3 2 1
1. Do you know the different covid-19 vaccine
and know how it will work to your body?
2. Do you believe that covid-19 vaccines can help
prevent corona virus disease?
3. Do you believe that covid-19 vaccines are
safe?
4. Do you consider some vaccine products
preventing covid-19?
5. Do you have any plans to receive any covid-19
vaccines?
6. Do you trust the information you received
about shots?
7. Do you think that people who have been
vaccinated against the coronavirus may get
corona infection again
8. Is herd immunity enough to protect everyone
from the coronavirus
9. Is it necessary to wear masks after taking the
coronavirus vaccine?
10. Do you think the vaccine itself infects us with
the coronavirus?