COVID-19 Virus Test Requisition (Pre-Filled)

1. Do you currently work in a long-term care home or retirement home?—Please choose an option—YesNo

a) If you selected yes, what best describes your job title? —Please choose an option—NursePersonal support workerPhysicianLaundry StaffKitchen staffCustodial/ Housekeeping staffReceptionsAdministrationOther

b) If you selected other, please describe your job title in a long-term care or retirement home:

c) ) If you selected no, please describe your job title:

2. Which section(s) of the website did you visit? CARE+Vaccine+IPAC+Saliva TestingWellness Hub for SheltersDried Blood Spot TestingWraparound ResourcesStudy InformationResearch OpportunitiesConsent FormsPublicationsOur TeamContact

3. How satisfied were you with the resources shared on the website pages you visited? —Please choose an option—1- Very unsatisfied2- Unsatisfied3- Neutral4- Satisfied5- Very Satisfied

4. What did you like and/or dislike about the resources on the website (e.g., topic of information/tools shared, layout, images etc.)?

5. Are there any additional resources or tools you would like to see added to the website?

6. How would you describe your overall experience with the website?—Please choose an option—1- Very unsatisfied2- Unsatisfied3- Neutral4- Satisfied5- Very Satisfied

1. Do you currently work in a long-term care home or retirement home?—Please choose an option—YesNo

a) If you selected yes, what best describes your job title? —Please choose an option—NursePersonal support workerPhysicianLaundry StaffKitchen staffCustodial/ Housekeeping staffReceptionsAdministrationOther

b) If you selected other, please describe your job title in a long-term care or retirement home:

c) ) If you selected no, please describe your job title:

2. Which section(s) of the website did you visit? CARE+Vaccine+IPAC+Saliva TestingWellness Hub for SheltersDried Blood Spot TestingWraparound ResourcesStudy InformationResearch OpportunitiesConsent FormsPublicationsOur TeamContact

3. How satisfied were you with the resources shared on the website pages you visited? —Please choose an option—1- Very unsatisfied2- Unsatisfied3- Neutral4- Satisfied5- Very Satisfied

4. What did you like and/or dislike about the resources on the website (e.g., topic of information/tools shared, layout, images etc.)?

5. Are there any additional resources or tools you would like to see added to the website?

6. How would you describe your overall experience with the website?—Please choose an option—1- Very unsatisfied2- Unsatisfied3- Neutral4- Satisfied5- Very Satisfied