Survey Questionnaire

Question 1.Select the state in which you are living currently?

Question 2. From which profession you are belongs to?

  Doctor

  Police Department

  Teaching Department.

  Others

Question 3. From which Age-Range you are belongs to?

  20-30 years

  30-40 years

  40-50 years.

  Above 50 years

Question 4. How many members in your family are above 50 years of age?

  1

  2

  3

  4 or more than 4

Question 5. At which price of vaccine, it is feasibly possible fr you to Vaccinate all your family member?

  Less than Rs.300.

  Rs.300 to Rs.400

  Rs. 400 to Rs.500

   More than Rs.500

Question 6. Do you support the Vaccine?

  Strongly Yes

  Yes

  No

  Can't Say

Question 7. What are the fears in getting yourself vaccinated?

  Vaccine will not work.

  Vaccine can harm our body.

  No fear

  Can't say anything

Question 8. As per Aarogya Setu app, how many people around you (within radius of 1km) have been affected in last 30 days?

  Less than 5.

  Between 5 & 10.

  Between 10 & 20.

  More than 20.

Question 9. Have you ever been infected with COVID-19?

  Yes

  No

Question 10. Are you suffering from any medical condition (such as Asthma,Diabetes,Heart disease?

  Yes

  No