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SANFL COVID-19 Vaccination Status and Consultation Survey

SANFL COVID-19 Vaccination Status and Consultation Survey

- Step 1 of 3

Personal Details

Please help us keep our records up to date.

Name *

First

Last

Phone *

Email *

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Postal Address (if different to residential)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Years of Consecutive Service

eg 5 years = started volunteering in 2016 with no break

I have read and understood the Club Volunteering Policies (see link in email). *

Yes

COVID-19 Vaccination Status & Consultation Survey

Identifying detail will be removed from responses for reporting purposes.

What is your vaccination status? *

I am fully vaccinated - I have had both doses
I am partially vaccinated - I have had one dose
I am not vaccinated yet - I have the intention to get vaccinated and have booked
I am not vaccinated yet - I have the intention to get vaccinated but have not yet booked
I am not vaccinated - I am unwilling or unable to, or am undecided

If fully vaccinated, when did you receive your second dose?

March
April
May
June
July
August
September
October
November

If you have the intention to get vaccinated, when is your booking or planning to be booked?

Within the next month
By the end of 2021
At some point in 2022
Have not thought about when, I just know I want to get vaccinated

If you do not have the intention to get vaccinated, or you are undecided, what is the main reason why?

I would only feel safe in the workplace alongside my peers if they are fully vaccinated. Please select:

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strong Disagree

I would only feel safe working with the program participants/patrons/members of the public (who are eligible) if they are vaccinated. Please select:

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strong Disagree

What questions or comments do you have for us in relation to this matter?

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