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C4R COVID-19 Questionnaire

Collaborative Cohort of Cohorts for COVID-19 Research

Survey/Questionnaire
Publicly Available, No Cost
01/01/2021
09/09/2021
The purpose of this questionnaire is to ascertain data on COVID-19 testing, self-reported COVID-19 diagnoses and hospitalizations, symptoms, recovery, re-infection, and vaccination. It also assesses the impact of the pandemic on access to healthcare, finances, health-related behaviors, social interactions, and mood. This questionnaire can be administered to individuals with no prior COVID assessments as well as those with prior COVID assessments. If prior assessments are available, text is provided to guide the interviewer to gather new information.

Additional Descriptors

  • Medical Professional, Researcher or Professional Interviewer, Self, Trained Non-Expert
  • Online or Mobile App, Paper, Phone Interview
    • RedCap
      • Chinese, English, Spanish
        • Survey/Questionnaire
          • Age
            • Age: Adult
            • Infectious Disease Outbreak
              • Biological or Infectious Agent
                • Biological or Infectious Agent: Virus
                  • Virus: SARS-CoV-2, SARS-CoV-1, MERS
                • Community Impacts, Diagnosis or Status or Treatment or Recovery, Symptoms
                  • Risk Reduction Behaviors: Vaccine-related

                Related Resources

                Files within the Disaster Research Response (DR2) Resources Portal may not be 508-compliant. If you need help accessing a specific file please contact dr2@niehs.nih.gov. NIEHS is working to make all files fully accessible and conformant.

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