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Recent Posts
DRNC Mask-Wearing Questionnaire
Published on:
July 1, 2024
DRNC Mask-Wearing Questionnaire
Step
1
of
8
12%
North Carolina has a new law that affects your ability to wear a mask in public. To measure its impact on people with disabilities, Disability Rights North Carolina (DRNC) is asking people to answer questions about their experience wearing a mask in public. We appreciate your participation and thank you for sharing your experiences with us.
Name
First
Last
Phone
Email
Preferred contact method
Phone
Email
NC county where you live
Select
Alamance County
Alexander County
Alleghany County
Anson County
Ashe County
Avery County
Beaufort County
Bertie County
Bladen County
Brunswick County
Buncombe County
Burke County
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Caldwell County
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Caswell County
Catawba County
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Clay County
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Craven County
Cumberland County
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Davie County
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Durham County
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Gates County
Graham County
Granville County
Greene County
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Halifax County
Harnett County
Haywood County
Henderson County
Hertford County
Hoke County
Hyde County
Iredell County
Jackson County
Johnston County
Jones County
Lee County
Lenoir County
Lincoln County
Macon County
Madison County
Martin County
McDowell County
Mecklenburg County
Mitchell County
Montgomery County
Moore County
Nash County
New Hanover County
Northampton County
Onslow County
Orange County
Pamlico County
Pasquotank County
Pender County
Perquimans County
Person County
Pitt County
Polk County
Randolph County
Richmond County
Robeson County
Rockingham County
Rowan County
Rutherford County
Sampson County
Scotland County
Stanly County
Stokes County
Surry County
Swain County
Transylvania County
Tyrrell County
Union County
Vance County
Wake County
Warren County
Washington County
Watauga County
Wayne County
Wilkes County
Wilson County
Yadkin County
Yancey County
Outside of NC
Do you have a disability that substantially limits any of your major life activities such as walking, driving, grocery shopping, etc…?
Yes
No
If no, are you associated with a person who has a disability?
Yes
No
If yes, please describe your relationship with this person.
Do you ever wear a mask when visiting public spaces?
Yes
No
If yes, why do you wear a mask? Examples include protection from COVID-19, allergy or asthma-related irritants, or poor air quality.
Have you been asked to remove your mask while in a public space?
Yes
No
This field is hidden when viewing the form
Follow-up Questions
If yes, when did this interaction occur?
Who asked you to remove your mask?
What was your response?
Was there a law enforcement officer involved?
Yes
No
Please describe what happened and provide any additional details.
How did this interaction affect you?
Have you experienced harassment such as unwanted contact or offensive comments in public while wearing a mask?
Yes
No
This field is hidden when viewing the form
Follow-up Questions
If yes, when did this interaction occur?
Who was involved in this interaction?
Please describe what happened and provide any additional details
How did this interaction affect you?
Have you experienced assault or a threat to your safety while wearing a mask in public?
Yes
No
This field is hidden when viewing the form
Follow-up Questions
If yes, when did this interaction occur?
Who was involved in this interaction?
Did this interaction involve physical contact?
Yes
No
Was law enforcement involved in this incident?
Yes
No
Please describe what happened and provide any additional details
How did this interaction affect you?
Have you been refused access to a space due to your use of a face mask?
Yes
No
This field is hidden when viewing the form
Follow-up Questions
If yes, when did this interaction occur?
Who refused your access?
Please describe what happened and provide any additional details
How did this interaction affect you?
How has hostility that you have faced while wearing a mask in public discouraged or kept you from engaging in public activities?
Is there any other information you wish to provide?
Are you interested in sharing your story publicly? This might include sharing through DRNC's own publications, media, in legal action, or something else we haven't thought of yet. Saying yes doesn't commit you to anything, and we would contact you directly before sharing your story.
Yes
No
Unsure
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Already on the list
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What is a P&A?
Our Team
Board of Directors
PAIMI Advisory Council
Impact Stories
Advocacy Targets
Careers
Our Work
Accessible Voting
Assistance Animals
Community Access and Inclusion
COVID-19 and Disability Rights
Criminal Legal
Disaster Recovery Project
Education Rights
Employment Rights
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TBI Justice Initiative
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