Business Contact Information for COVID-19

Question Title

* 1. There may be times that the health department needs to speak with someone urgently about a COVID-19 exposure at your workplace.

Please provide the name of the best After-Hours Contact Person for your business or organization, as well as that person's after-hours phone number and e-mail address.

Name

Company

Email Address

Phone Number

Question Title

* 2. Location of Business/Organization
(if multiple, provide the main address within Barry or Eaton counties)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Question Title

* 3. What is the nature of your business/organization? (check all that apply)

Office

Manufacturing / Industrial / Warehouse

Agriculture

Retail (including Grocery)

Restaurant or other Food Service

Healthcare

Schools / Childcare

Construction / Outdoor Work

Community Services / Governmental

Delivery

Other (please specify)

Question Title

* 4. Approximately how many employees are currently working in-person? (Do not include employees who are working remotely)

0-5

6-10

11-20

21-50

51-100

101-500

More than 500