DRNC Mask-Wearing Questionnaire Published on: July 1, 2024 Table of Contents 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 PhoneEmail Preferred contact method Phone Email NC county where you liveSelectAlamance CountyAlexander CountyAlleghany CountyAnson CountyAshe CountyAvery CountyBeaufort CountyBertie CountyBladen CountyBrunswick CountyBuncombe CountyBurke CountyCabarrus CountyCaldwell CountyCamden CountyCarteret CountyCaswell CountyCatawba CountyChatham CountyCherokee CountyChowan CountyClay CountyCleveland CountyColumbus CountyCraven CountyCumberland CountyCurrituck CountyDare CountyDavidson CountyDavie CountyDuplin CountyDurham CountyEdgecombe CountyForsyth CountyFranklin CountyGaston CountyGates CountyGraham CountyGranville CountyGreene CountyGuilford CountyHalifax CountyHarnett CountyHaywood CountyHenderson CountyHertford CountyHoke CountyHyde CountyIredell CountyJackson CountyJohnston CountyJones CountyLee CountyLenoir CountyLincoln CountyMacon CountyMadison CountyMartin CountyMcDowell CountyMecklenburg CountyMitchell CountyMontgomery CountyMoore CountyNash CountyNew Hanover CountyNorthampton CountyOnslow CountyOrange CountyPamlico CountyPasquotank CountyPender CountyPerquimans CountyPerson CountyPitt CountyPolk CountyRandolph CountyRichmond CountyRobeson CountyRockingham CountyRowan CountyRutherford CountySampson CountyScotland CountyStanly CountyStokes CountySurry CountySwain CountyTransylvania CountyTyrrell CountyUnion CountyVance CountyWake CountyWarren CountyWashington CountyWatauga CountyWayne CountyWilkes CountyWilson CountyYadkin CountyYancey CountyOutside of NCDo 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 formFollow-up QuestionsIf 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 formFollow-up QuestionsIf yes, when did this interaction occur?Who was involved in this interaction?Please describe what happened and provide any additional detailsHow 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 formFollow-up QuestionsIf 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 detailsHow 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 formFollow-up QuestionsIf yes, when did this interaction occur?Who refused your access?Please describe what happened and provide any additional detailsHow 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 Would you like to sign up for DRNC’s newsletter? Yes No Already on the list Email for Newsletter Signup Did you find what you needed today? Let us know so we can improve! Yes No Share Download PDF
