Questions assessing prevention measures against COVID-19
Prevention measures Option answer
Personal protection
Wear a mask [ ] Rarely [ ] Occasionally [ ] Often [ ] Always Eye protection [ ] Rarely [ ] Occasionally [ ] Often [ ] Always Wash hand frequently with soap [ ] Rarely [ ] Occasionally [ ] Often [ ] Always Avoid touching your eyes, nose, and mouth [ ] Rarely [ ] Occasionally [ ] Often [ ] Always Etiquette/Cough Etiquette
Cover mouth and nose with tissue when cough or sneeze.
[ ] Rarely [ ] Occasionally [ ] Often [ ] Always Dispose tissue paper immediately after
coughing or sneezing
[ ] Rarely [ ] Occasionally [ ] Often [ ] Always Wash hand immediately after coughing or
sneezing.
[ ] Rarely [ ] Occasionally [ ] Often [ ] Always Perform hand hygiene (e.g., hand washing with
or antiseptic handwash) after having contact with respiratory secretions or contaminated objects
[ ] Rarely [ ] Occasionally [ ] Often [ ] Always
Contact precautious
Avoid proximity (closeness) with other people [ ] Rarely [ ] Occasionally [ ] Often [ ] Always Avoid group gathering [ ] Rarely [ ] Occasionally [ ] Often [ ] Always Voluntary quarantine
[ ] Rarely [ ] Occasionally [ ] Often [ ] Always If I am feeling unwell, I distance myself from
others
[ ] Rarely [ ] Occasionally [ ] Often [ ] Always
Prompt reporting
If I am feeling unwell, I will immediately declare my symptoms to the authority/healthcare providers
