This is a Google Form to be used by Psychologists, Social Workers, School Counselors and Administration to check-in with teachers and school staff during distance learning due to COVID-19 school shut-downs. The form is aimed to gauge how teachers are feeling and to allow them to share how they are being impacted by becoming a virtual teacher during the pandemic.

As is, the form gathers the following information: "What emotions have you been feeling this week?", rating of stress level, rating of sleep quality, checking difficulties that have been experienced during virtual learning, asking about specific concerns regarding students, asking for suggestions as to how teachers and students could be better supported at this time.

This resource is fully editable for customization.

The form is intended to include a link to a mindfulness practice. If this form is sent out weekly, a YouTube link for a new mindfulness practice should be input for teachers to practice a method of self-care.

This Google Form can be customized/edited to fit your needs. There is an option for data to be output into a Google Sheets format to be used for data collection and to keep track of contact with students responding to the form. This is an easy way to document student outreach during the school shut-down!

Keep faculty feeling connected and supported!