Study participants quarterly interviews

SHIPS
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Quarterly Work & Housing Interview
Record ID.

__________________________________

Quarterly Work and Housing Interview
Reminder about resources to help you cope with distress.  
When you enrolled in this study, you were provided with a list of resources to help you cope
with negative feelings and reactions to these interviews.  These resources can also help you
with other problems in your life not related to the study.
If you do not remember receiving this information, we will provide it to you immediately
following this interview.
What is the interview period?

Data Entry Date

Interview Date

__________________________________

__________________________________

__________________________________

Employment. We will now ask you about any jobs you held in the past three months.
Have you worked at a job or business for pay since the
last interview/in the last three months?

Yes
No

How many jobs have you held in the last three months?

1
2
3

MAIN Job: Who is/was your employer?

MAIN Job: What is/was your hourly wage?

MAIN Job: About how many hours per day did you work?

MAIN Job: About how many days per week did you work?

05/01/2024 12:10pm

__________________________________
(employer name)

__________________________________
(Please enter a number with 2 decimal places (i.e.
12.50).)

__________________________________
(Please enter an integer from 1 to 24)

__________________________________
(Please enter an integer from 1 to 7)

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MAIN Job: How many weeks have you worked during the
past three months?

__________________________________
(Please enter an integer from 1 to 12.)

MAIN Job: Are you still working there?

Yes
No

MAIN Job: What was the nature of the job ending?

quit
fired
laid off
time-limited
reassignment
other

SECOND Job: Who is/was your employer?

SECOND Job: What is/was your hourly wage?

SECOND Job: About how many hours per day did you work?

SECOND Job: About how many days per week did you work?

SECOND Job: How many weeks have you worked during the
past three months?

__________________________________
(employer name)

__________________________________
(Please enter a number with 2 decimal places (i.e.
12.50).)

__________________________________
(Please enter an integer from 1 to 24)

__________________________________
(Please enter an integer from 1 to 7)

__________________________________
(Please enter an integer from 1 to 12.)

SECOND Job: Are you still working there?

Yes
No

SECOND Job: What was the nature of the job ending?

quit
fired
laid off
time-limited
reassignment
other

THIRD Job: Who is/was your employer?

THIRD Job: What is/was your hourly wage?

THIRD Job: About how many hours per day did you work?

05/01/2024 12:10pm

__________________________________
(employer name)

__________________________________
(Please enter a number with 2 decimal places (i.e.
12.50).)

__________________________________
(Please enter an integer from 1 to 24)

projectredcap.org

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THIRD Job: About how many days per week did you work?

THIRD Job: How many weeks have you worked during the
past three months?

__________________________________
(Please enter an integer from 1 to 7)

__________________________________
(Please enter an integer from 1 to 12.)

THIRD Job: Are you still working there?

Yes
No

THIRD Job: What was the nature of the job ending?

quit
fired
laid off
time-limited
reassignment
other

Current Housing. We will now ask you about your housing in the past three months.
During the past three months, how many different
supportive housing units have you lived in?

1
2
3

Are you currently living in your supportive housing
unit?

Yes
No
Prefer not to answer

Please indicate any other place you have slept for at
least one night during the past three months:

My own apartment or home
Someone else's apartment or home
In a shelter, emergency, temporary housing
Hotel/motel provided by an agency
Outside on the street, park, or beach
Tent or makeshift shelter
In a bus station, train station, airport
Abandoned building
In a vehicle (car, van, RV, truck)
An institution, hospital, or facility
None of these

What type of institution, hospital, or facility did
you stay in? (select all that apply)

Hospital
Substance abuse treatment, detox, or recovery
center/rehab
Jail, prison, or juvenile detention facility
Foster home or group home
Long-term care facility, nursing home, or Board
and Care
Prefer not to answer

05/01/2024 12:10pm

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If you stayed in more than one place, where did you
stay the most?

05/01/2024 12:10pm

I did not stay in more than one place
Someone else's apartment or home
In a shelter, emergency, temporary housing
Hotel/motel provided by an agency
Outside on the street, park, or beach
Tent or makeshift shelter
In a bus station, train station, airport
Abandoned building
In a vehicle (car, van, RV, truck)
An institution, hospital, or facility
None of these

projectredcap.org