Servicing Flow - Quick access
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Province
*
Western Cape
Eastern Cape
KZN
Gauteng
Limpopo
Mpumalanga
Northen Cape
Free State
This is the province you are living please, where you are now sleeping
Age Category
*
0-9
10-19
20-29
30-39
40-49
50-59
60+
The current age group you fall in to today
Existing Ailments
*
Cardio-Vascular (Heart Problems)
Renal Diseases (Kidney Problems)
Diabetes
Respiratory Diseases Chronic Obstructive pulmonary (Asthma, Lung Cancer)
Tuberculosis (TB)
Cancer (In last 5 years - Except Lung)
Hypertension
None of These
Smoke
*
Yes
Socially will
Quit more then 1 year
Never
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Do you weare a mask when you go out of the house
*
Yes
No
Only when see others wearing it
Do you Sanitize your hands before touching mouth, ears & nose
*
Never
Sometimes I do touch unwillingly
Always
When do you sanitize your hands?
*
Never
Only After Returning Home
Every time enter place of work, touch money or use public facilities
Do you observe and follow physical social distance norms
*
Never
Only when i see others
Always
How Anxious are you about current situation
*
Slightly concerned although no one i know has direct reported case
Fairly concerned but numbers are low in my region
Quite concerned as one reported in my residence, building, street
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Occupation Type - you a service provider or other?
*
Emergency or Medical
Law and Order
Essential Services (Retailing Commodities)
Other
What do you think response action
*
Need new measures to bring under control
Current measures will bring it under control
Situation is under control
Is any of this true?
*
Attended a public meeting, gathering, weeding, party or such in last 14 days
I ve used public transport or air travel in last 14 days
Both of the above
None of the above
How Effective is lock-down in your area
*
All shops open and gatherings allowed
Essential services and shops open no restriction on movement
Only essential services and no movement restriction
Are people wearing masks?
*
Some (Below - 50%)
Many (50%-80%)
Lots (80% or more)
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