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* 1. Please complete your contact information below

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* 2. What is the current operating status of your business?

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* 3. What was the date of your reopening?

Date

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* 4. What is the date of closure?

Date

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* 5. What is your current total employee count?

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* 6. Has your employee count changed due to COVID 19 specifically?

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* 7. Please indicate your workforce change in each category

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* 8. What percentage of your workforce is currently working remotely?

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i We adjusted the number you entered based on the slider’s scale.

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* 9. Have you implemented new safety measures in your facility or business? 

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* 10. Please describe what safety measures you've put in place

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* 11. Has your company’s weekly revenue experienced an increase or decrease as a result of COVID-19?

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* 14. Have you applied for a US Small Business Administration Economic Injury Disaster Loan?

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* 15. Have you applied for the Payroll Protection Program?

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* 16. PPP Loan

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* 18. Have you had supply chain disruptions due to COVID 19?

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* 19. As the state moves toward re-opening, what challenges do you foresee for your business?

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* 20. What other business supports would you think beneficial as we navigate this global challenge?

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