Phase 1B Survey for Individuals (75 years of age and older; critical/essential workers)

Central Michigan District Health Department is looking to collect some information at this time from individuals who are 75 years of age or older OR individuals who work in a critical/essential workforce.

More information on Critical/Essential Workers can be found at:  https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce. The MDHHS Prioritization Guidance for Critical/Essential/Front Line Workers may change.

We ask that you answer the questions in this survey as best as you can. An email address is required. Thank you for your time.

1. Today's Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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4. If you are a critical/essential employee, please provide the name of your facility/organization?

6. What is your first and last name? *This question is required.

7. What is your phone number?

8. What is your email address? This question requires a valid email address.

9. Comments (i.e. no internet)