SVHM/STAGE-28 Mental health Portal

SVHM

Demographics

STAGE-28 Trial

Thank you for providing your consent to participate in the STAGE-28 trial at St Vincent’s Hospital Melbourne. This is a reminder that if you wish to withdraw at any time, please let us know, so that your data can be traced and deleted. Contact details, further information and how to raise concerns appear on the Participant Information and Consent Form which can be downloaded here.

Two initials plus 4-digit birthday and month For example: for Joe Smith born 24/08/77 enter: ‘JS2408’
Age:
Gender:
Do you identify as Aboriginal or Torres Strait Islander?
Were you, or one of your parents, born overseas?
Do you speak a language other than English?
Years of Service at SVHM:
Which setting do you work in?
What is your typical work shift?
Are you qualified in your patient area?
Are you a STAR peer support member?
Are you a graduate student?

In the last 12 months did you…

..work in Covid-19 related areas?
..work from home?
Were you ever quarantined?
Did you care for a patient with Covid-19?
Did you care for anyone who died?
Did you contract Covid-19 yourself?
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