England Mortality Survey 2021 -22
If you know of a relative, close friend, neighbour or work colleague in England who died since the start of 2021, please complete this survey to assist us in an important mortality analysis.

Question Title

* 1. Country of death

Question Title

* 2. Name of deceased (hashed using https://passwordsgenerator.net/sha256-hash-generator/)

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* 3. Your relationship with the deceased

Relative

Close friend

Neighbour

Work colleague

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* 4. Age of deceased

18-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

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* 5. Date of death

Date / Time

Date

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* 6. Was the deceased COVID vaccinated?

Yes

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* 7. How many doses of the COVID vaccine?

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* 8. Was the death sudden or unexpected?

Yes

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* 9. What was the cause of death (tick all that apply)?

Cancer

Heart disease

Sudden cardiac arrest

Influenza/pneumonia

COVID-19

Dementia/Alzheimer's

Chronic lower respiratory disease

Cerebrovascular diseases

Accident/misadventure

Other

Question Title

* 10. Are you COVID vaccinated?

Yes

England Mortality Survey 2021 -22If you know of a relative, close friend, neighbour or work colleague in England who died since the start of 2021, please complete this survey to assist us in an important mortality analysis.

Question Title

* 1. Country of death

Question Title

* 2. Name of deceased (hashed using https://passwordsgenerator.net/sha256-hash-generator/)

Question Title

* 3. Your relationship with the deceased

Question Title

* 4. Age of deceased

Question Title

* 5. Date of death

Question Title

* 6. Was the deceased COVID vaccinated?

Question Title

* 7. How many doses of the COVID vaccine?

Question Title

* 8. Was the death sudden or unexpected?

Question Title

* 9. What was the cause of death (tick all that apply)?

Question Title

* 10. Are you COVID vaccinated?

England Mortality Survey 2021 -22
If you know of a relative, close friend, neighbour or work colleague in England who died since the start of 2021, please complete this survey to assist us in an important mortality analysis.