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Hygiene Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Do you wash your hands regularly?
Choose the option that best fits your situation
Always
Sometimes
Never
2
Rate the cleanliness of your living environment
Rate from 1 to 10 (1 being very dirty, 10 being very clean)
3
How often do you brush your teeth?
Please provide a brief description
4
Do you disinfect commonly touched surfaces regularly?
Choose the option that best fits your situation
Yes
No
Sometimes
5
How often do you change your bed sheets?
Choose the option that best fits your situation
Weekly
Monthly
Rarely
6
Rate your personal hygiene routine
Rate from 1 to 10 (1 being very poor, 10 being excellent)
7
Do you cover your mouth when sneezing or coughing?
Choose the option that best fits your behavior
Always
Sometimes
Never
8
How often do you clean your bathroom?
Choose the option that best fits your cleaning frequency
Daily
Weekly
Monthly
9
Describe your handwashing routine
Provide details about when and how you wash your hands
10
Rate how important hygiene is to you
Rate from 1 to 10 (1 being not important, 10 being very important)
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