Province
District
Sub District
Village
Total
Male
Female
Not Answer
Total
Low
Moderate
High
- Component A
- POTENTIALS INFECTED OUTSIDE THE HOUSE
1.
I go out of the house
2.
I use public transportation: online (Gojek/Grab), public transportation, bus, taxi, train
3.
I do not wear a mask at the time of gathering with others
4.
I shake hands with others
5.
I do not clean my hands with hand sanitizer / wet tissue before driving the car / motorcycle
6.
I touch objects / money that other people did
7.
I don't keep a distance of 1.5 meters from other people when: shopping, working, studying, and worshiping
8.
I eat/buy food outside the house (food stall/restaurant)
9.
I don't drink warm & wash my hands with soap after arriving at the destination
10.
I am in the area where patient(s) is/are infected
- Component B
- POTENTIALS INFECTED IN THE HOUSE
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.
12.
I don't wash my hands with soap after arriving home.
13.
I do not provide: wet tissue/antiseptic, masks, antiseptic soap for my family at home.
14.
I do not immediately soak the shirt & pants used outdoors into hot water/soap.
15.
I don't take a bath to wash after I got home.
16.
I do not socialize private risk assessment check list to my family at home.
- Component C
- BODY RESISTANCE (IMUNITY)
17.
I haven't been exposed to sunlight for at least 15 minutes a day.
18.
I don't walk/exercise at least 30 minutes every day.
19.
I rarely take vitamins C & E, and lack of sleep.
20.
I am over 60 years old.
21.
I have a disease: heart / diabetes / chronic respiratory problems