Province
District
Sub District
Village
Total
Male
Female
Not Answer
Total
Low
Moderate
High
Component A
POTENTIALS INFECTED OUTSIDE THE HOUSE
  1. 1.

    I go out of the house

  2. 2.

    I use public transportation: online (Gojek/Grab), public transportation, bus, taxi, train

  3. 3.

    I do not wear a mask at the time of gathering with others

  4. 4.

    I shake hands with others

  5. 5.

    I do not clean my hands with hand sanitizer / wet tissue before driving the car / motorcycle

  6. 6.

    I touch objects / money that other people did

  7. 7.

    I don't keep a distance of 1.5 meters from other people when: shopping, working, studying, and worshiping

  8. 8.

    I eat/buy food outside the house (food stall/restaurant)

  9. 9.

    I don't drink warm & wash my hands with soap after arriving at the destination

  10. 10.

    I am in the area where patient(s) is/are infected

Component B
POTENTIALS INFECTED IN THE HOUSE
  1. 11.

    I do not attach hand sanitizer at the front entrance, to clean hands before holding the handle(s) of the entrance of the house.

  2. 12.

    I don't wash my hands with soap after arriving home.

  3. 13.

    I do not provide: wet tissue/antiseptic, masks, antiseptic soap for my family at home.

  4. 14.

    I do not immediately soak the shirt & pants used outdoors into hot water/soap.

  5. 15.

    I don't take a bath to wash after I got home.

  6. 16.

    I do not socialize private risk assessment check list to my family at home.

Component C
BODY RESISTANCE (IMUNITY)
  1. 17.

    I haven't been exposed to sunlight for at least 15 minutes a day.

  2. 18.

    I don't walk/exercise at least 30 minutes every day.

  3. 19.

    I rarely take vitamins C & E, and lack of sleep.

  4. 20.

    I am over 60 years old.

  5. 21.

    I have a disease: heart / diabetes / chronic respiratory problems