Survey 2 | AlohaTrace | Hawaii Community Effort to Combat COVID-19

Sorry to hear you’re not feeling well.

Question 5 of 6
Q5. Did you go anywhere over the past two days?
- See family/friends
- Doctor/Hospital
- Beach/Park
- Grocery/Drug Store
- Pickup food
- Work
- Other
- No, just stayed at home
Work Location
Name Street City Zip Code

Please list the company, street, city and zip code of the work location you visited.
Food Location
Name Shopping Center City Zip Code

Please list the name, shopping center (if known), city and zip code of the food location you visited.
Medical Location
Medical Building City Zip Code

Please list the medical building, city and zip code of the doctors/hospitals you have been to.
Family And Friends Location
Street City Zip Code

Please list the neighborhood city and zip code of the family and friends house you visited.
Beach Park Location
Beach/Park City Zip Code

Please list the beach/park, city and zip code of the locations you have been to.
Other Location
Location Street City Zip Code

Please list the location name, neighborhood city and zip code you have been to.
Grocery/Drug Store Location
Store Shopping Center City Zip Code

Please list the store name, shopping center (if known), city and zip code of the stores you have been to.

Name	Street	City	Zip Code

Name	Shopping Center	City	Zip Code

Medical Building	City	Zip Code

Street	City	Zip Code

Sorry to hear you’re not feeling well.