ROTA – Long Covid Research Project Questionnaire

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* 1. What is your age?

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* 2. Are you:

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* 3. Do you have any dependents?

Yes

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* 4. What is your ethnic group or background?

Caribbean

West African

East African

South African

Central African

Mixed (any combination of the previously mentioned groups)

Mixed (any of the previous groups and White)

Mixed (any of the previous groups and a group not mentioned)

Other (please specify)

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* 5. What is your current work status?

Working full-time

Working part-time

Not working because of COVID-19

Not working because of other reasons

Studying full time

Studying and working

Retired

Other (please specify)

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* 6. What is your household income?

Below £20,000

£20,000 - £30,000

£30,001 - £40,000

£40,001 - £70,000

Above £70,000

Prefer not to say

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* 7. Which region does your main residence fall within?

North East

North West

Yorkshire and Humberside

East Midlands

West Midlands

London

South East

South West

Wales

Scotland

Northern Ireland

Other

I prefer not to say

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* 8. Have you had Covid 19?

Yes

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* 9. If Yes, did you:· Self-treat at home, Receive treatment in hospital but not intensive care, Receive treatment in intensive care? (write your answer below)