Gypsy & Traveller Community Questionnaire The Traveller Health Team is very keen to support you during the corona virus (Covid-19) crisis. In order to do this we need to ask you some questions. Your answers will only be used to support you during the current health crisis. OK Question Title * 1. In which region are you currently staying? East of England East Midlands Greater London North East North West South East South West West Midlands Yorkshire and the Humber OK Question Title * 2. HOW ARE YOU COPING? Do you have any specific concerns about coping with Covid-19? OK Question Title * 3. SUPPORTING YOUR HOUSEHOLD – your household is anyone who shares your home or your pitch on a site.Does your household have access to food, medicines and supplies? If not, we can help organise support with this. Yes No OK Question Title * 4. SUPPORTING YOUR HOUSEHOLD – your household is anyone who shares your home or your pitch on a site.Do you have access to the following without somebody having to leave your household?Rubbish collection? Yes No OK Question Title * 5. SUPPORTING YOUR HOUSEHOLD – your household is anyone who shares your home or your pitch on a site.Do you have access to the following without somebody having to leave your household:Clean water? Yes No OK Question Title * 6. SUPPORTING YOUR HOUSEHOLD – your household is anyone who shares your home or your pitch on a site.Do you have access to the following without someone having to leave the household?Toilets with hygienic waste disposal? Yes No OK Question Title * 7. SUPPORTING YOUR HOUSEHOLD – your household is anyone who shares your home or your pitch on a site.If you would like more support with any of the above issues, please fill in your contact details below and someone from the Traveller Health Team will contact you (contact details will remain confidential). Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK Question Title * 8. Covid-19 Do you feel you have got the information you need about Covid-19? Yes No OK Question Title * 9. Covid-19If somebody in your household has symptoms suggestive of Covid-19 such as a new, continuous cough and/or high temperature (37.8C or higher) they should self isolate themselves for 7 days and anyone living with them should self isolate for 14 days. Would you or any member of your household be able to self-isolate to reduce the risk of spreading the infection? Yes No OK Question Title * 10. Covid-19Where do you get your news and information about Covid-19 from? E.g. BBC, Travellers Times, Facebook, Whatsapp etc BBC Travellers Times Facebook Twitter Other social media Other (please specify) OK Question Title * 11. Covid-19How would you like to get information about Covid-19? E.g. video, audio files, leaflets VIdeo Audio files Leaflets Text messages Other (please specify) OK Question Title * 12. Covid-19If you would like to volunteer to support your community during Covid-19, please fill in your contact details below and someone from the Traveller Health Team will contact you (contact details will remain confidential). Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK DONE