Collecting Covid: Wales 2021

There are two sections to this questionnaire. The information contained within Part 1 will be made available to researchers and other members of the public. The information contained within Part 2 is personal and will be held securely and not shared with anyone, unless the Museum is obligated to do so for legal purposes. Your name and contact details will be used by the Museum to manage your contribution. The information will also be anonymised and used to help build a statistical profile of Wales during COVID-19.

Part 1

Daily Life Has the pandemic changed your relationships with others? For example, your family, friends or neighbours?

How have you been connecting/communicating with others during this time?

If you work, attend school or a college/university, how has the pandemic impacted on your experience? Collecting Covid: Wales 2021

What has been your experience of family or community events during the pandemic – e.g. funerals, weddings, social or religious festivals?

During the pandemic, have you discovered anything new about your local area – e.g. the natural environment or history/archaeology?

Health and Wellbeing Have you needed to access or been unable to access any medical, social care services or safe spaces?

What are your thoughts on the vaccine? Tell us about your experience. Collecting Covid: Wales 2021

How are you feeling emotionally? Have your feelings changed over time, and through the various lockdowns?

What has been the most difficult experience for you since the start of the pandemic?

What has been the most positive experience for you since the start of the pandemic?

Government and Information How do you feel about the Welsh Government and the UK Government’s response to the crisis? Collecting Covid: Wales 2021

What aspects of lockdown restrictions have affected you most?

How are you feeling about the easing of restrictions and unlocking of society?

The Future What things or moments during the pandemic will stay in your mind?

How will life be different for you? Collecting Covid: Wales 2021

We may wish to follow-up on your story, are you happy for us to contact you?

Yes No

If we share your story, how would you like to be named:

We understand that sharing your story might be difficult at this time. For wellbeing advice and support, the following helplines and resources are available: Bawso 0800 731 8147 LGBT Cymru Helpline 0800 840 2069 Live Fear Free Helpline 0808 80 10 800 Mind Cymru 0300 123 3093 Wales Learning Disability Helpline 0808 8000 300 Collecting Covid: Wales 2021

Part 2

About You

Full name: Postcode:

Email address: Year of birth:

Which language(s) do you speak?

What is your language of choice?

Please choose the options that you most closely identify with, or feel free to select ‘self-describe’ and tell us in your own words. If you do not want to share, please select ‘prefer not to say’.

Gender: Female Male Non-binary Prefer not to say Is your gender identity the same as the gender you were given at birth?

Yes No Prefer not to say

Sexual orientation: Gay/Lesbian Bisexual Straight (heterosexual) Prefer not to say Self-describe

Relationship status: Single Married / Civil partnership Widowed

In a relationship (not living together) In a relationship (living together)

Prefer not to say

Nationality: Collecting Covid: Wales 2021

Broad ethnicity: Asian Arab Black Romany / gypsy / traveler Mixed ethnic group White Prefer not to say Self-describe

Religious belief: Buddhist Christian Hindu Jewish Muslim Sikh

Prefer not to say No religion Self-describe

Do you have any of the following conditions? Learning disability Long-term illness/condition Sensory impairment

Mental health condition Physical impairment Prefer not to say

Other, please self-describe

Participation and Use Agreement The collecting and recording of people’s memories about life in Wales has always been an important part of the work of Amgueddfa Cymru - National Museum Wales (the Museum), it is part of our Royal Charter and is integral to our Public Task. The Museum’s aim is to safeguard these memories, and your contribution will form part of the National Collection and be archived in the public interest. This agreement will allow the Museum to permanently preserve and use your contribution and ensure that it is added to the Museum’s collection. I agree that my contribution will become part of the National Collection cared for by Amgueddfa Cymru – National Museum Wales. It will be preserved as a permanent public reference resource, for use in research, publication, education, lectures, broadcasting, online and digital resources, and also third-party use deemed appropriate by the Museum. If I am under 18 my parent or legal guardian has agreed to my participation, and to the use of any photographs (of or by me), and any audio/visual contributions, and has completed the demographic information on my behalf.

Copyright Agreement I declare that I am the legal owner, free from encumbrance, of the material uploaded, and I hereby donate them to the Museum as an absolute and perpetual gift. I am the copyright holder of the contribution I have uploaded and fully and permanently assign to Amgueddfa Cymru – National Museum Wales all copyright. However, if I want to, I may still use the material I have uploaded for my own personal use. I understand that my name and contact details will be used by the Museum to manage this contract. Collecting Covid: Wales 2021

Your Personal Data Your name will only be used as you have specified in the questionnaire. The Museum will deal responsibly and with integrity every time your contribution is used and will make sure to extend courtesy to contributors as appropriate. For information about how the Museum will use your personal data you can review our Privacy Policy at https://museum.wales/privacy-notice.

Signature: Date:

Thank you for taking part Please return your completed questionnaire and signed participation agreement by post or email. Collecting Covid St Fagans National Museum of History St Fagans, Cardiff , CF5 6XB [email protected]

Thank you to the following groups and organisations for their help and support in developing this questionnaire.