Impressum | Datenschutz
Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters.

CoKi Survey on Protective Masks for Mouth and Nose Covering

Dear survey participant!

 

You have an opportunity here to document your observations on the effects that have occurred when one or more of your children was wearing a usual protective mask for mouth and nose covering (hereinafter referred to as masks).

With the corona pandemic, a situation has arisen in which research relies on the data relating to children and adolescents (hereinafter referred to as children) in order to make scientific statements concerning children. You can make a decisive contribution to this. Please help us by answering the following questions! Every input is important. Please be honest and do not exaggerate.

 

Thank you very much

Dr. med. Silke Schwarz and Prof. Dr. med. David Martin (University of Witten / Herdecke)

 

Data protection for voluntary participation:

Your participation is of course voluntary and anonymous. You are free to cancel your participation at any time without incurring any disadvantages. Professional discretion and data protection are guaranteed. Your information is strictly confidential and processed anonymously, i.e. no names, initials, addresses or other identifying variables are used. Accordingly, no statements can be deleted retrospectively on request. Times and dates are not saved, but responses are time-stamped. IP addresses of the respondents are not recorded! Google Analytics settings: None. The data are only accessible to the researchers involved in the study and will not be passed on to third parties at any time.

Details about your person
Please enter your age:
What is your highest level of education?
(This question is mandatory)
Please select your country.
(This question is mandatory)
Please select your state:
(This question is mandatory)
In what role do you fill out this survey?
How many children do you have?
Information on the 1st child
(This question is mandatory)
Please enter the age of the child you are reporting about:
Please indicate the gender of the child:
Does your child have any previous illnesses?
The child wears a mask in the following situations:
Approximate wearing time of a mask on an average day:
Please enter your answer in hours and minutes.
What kind of mask is your child mainly wearing?
Does the child complain about any difficulties from wearing a mask?
Do you notice any difficulties your child has from wearing a mask?
Symptoms observed in the child after the prolonged wearing of a mask:
Any observed health impairment of the child through wearing a mask ...
Other abnormalities in the child's behavior:
Please describe the fears that the child has developed from wearing a mask:
(This question is mandatory)
Would you like to enter data for another child?
Information about the 2nd child
(This question is mandatory)
Please enter the age of the child you are reporting about:
Please indicate the gender of the child:
Does your child have any previous illnesses?
The child wears a mask in the following situations:
Approximate wearing time of a mask on an average day:
Please enter your answer in hours and minutes.
What kind of mask is your child wearing?
Does the child complain about any difficulties from wearing a mask?
Do you notice any difficulties your child has from wearing a mask?
Symptoms observed in the child after the prolonged wearing of a mask:
Any observed health impairment of the child through wearing a mask ...
Other abnormalities in the child's behavior:
Please describe the fears that the child has developed from wearing a mask:
(This question is mandatory)
Would you like to enter data for another child?
Information about the 3rd child
(This question is mandatory)
Please enter the age of the child you are reporting about:
Please indicate the gender of the child:
Does your child have any previous illnesses?
The child wears a mask in the following situations:
Approximate wearing time of a mask on an average day:
Please enter your answer in hours and minutes.
What kind of mask is your child wearing?
Does the child complain about any difficulties from wearing a mask?
Do you notice any difficulties your child has from wearing a mask?
Symptoms observed in the child after the prolonged wearing of a mask:
Any observed health impairment of the child through wearing a mask ...
Other abnormalities in the child's behavior:
Please describe the fears that the child has developed from wearing a mask:
(This question is mandatory)
Would you like to enter data for another child?
Information about the 4th child
(This question is mandatory)
Please enter the age of the child you are reporting about:
Please indicate the gender of the child:
Does your child have any previous illnesses?
The child wears a mask in the following situations:
Approximate wearing time of a mask on an average day:
Please enter your answer in hours and minutes.
What kind of mask is your child wearing?
Does the child complain about any difficulties from wearing a mask?
Do you notice any difficulties your child has from wearing a mask?
Symptoms observed in the child after the prolonged wearing of a mask:
Any observed health impairment of the child through wearing a mask ...
Other abnormalities in the child's behavior:
Please describe the fears that the child has developed from wearing a mask:
(This question is mandatory)
Would you like to enter data for another child?
Information about the 5th child
(This question is mandatory)
Please enter the age of the child you are reporting about:
Please indicate the gender of the child:
Does your child have any previous illnesses?
The child wears a mask in the following situations:
Approximate wearing time of a mask on an average day:
Please enter your answer in hours and minutes.
What kind of mask is your child wearing?
Does the child complain about any difficulties from wearing a mask?
Do you notice any difficulties your child has from wearing a mask?
Symptoms observed in the child after the prolonged wearing of a mask:
Any observed health impairment of the child through wearing a mask ...
Other abnormalities in the child's behavior:
Please describe the fears that the child has developed from wearing a mask:
Personal attitude
I would describe my attitude to the government's corona protective measures as follows:
Please describe your personal attitude towards the mask requirement:
E-Mail

You can leave your name and an email address here for contact purposes.

Your data set is then no longer anonymous. Your personal data will continue to be treated confidentially by us in accordance with the GDPR and will not be published or passed on to third parties.

If you would like to send us a message, please use the e-mail addresses given on the following page.