Page 253 - QAP Manual 2020

18. PROXY ALLOWED Do you need more help or reminders to wear a mask when you go
outside or to places where other people are?
Other respondent: Does this person need more help or reminders to wear a mask when he/she
goes outside or to places where other people are?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other

 2. I need more help and/or reminders to do this
 1. I don’t need more help and/or reminders to do this
 99. Don’t know

19. PROXY ALLOWED Is there always a clean mask for you to use when you want or need
one?
Other respondent: Is there always a clean mask for this person to use when he/she wants or needs
one?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other

 2. Yes, always
 3. Sometimes
 1. No
 99. Don’t know

20. PROXY ALLOWED Do you need more help or reminders to stay far enough away from
people when you’re out in the community so germs don’t spread? (This is sometimes
called “social distancing” or “physical distancing” and means you should stay far enough
away from people you don’t know, and friends, family and staff who do not live with
you)?
Other respondent: Does this person need more help or reminders to stay far enough away from
other people when out in the community so germs don’t spread? (This is sometimes called “social
distancing” or “physical distancing” and means he/she should stay far enough away from people
he/she does not know, and friends, family and staff who do not live with him/her)?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other
 2. I need more help and/or reminders to do this
 1. I don’t need more help and/or reminders to do this
 99. Don’t know