The City of Wadsworth Economic Development Department is coordinating an effort to assess the economic impacts related to COVID-19. If you represent a business or non-profit organization in the City of Wadsworth, please help us understand what your business is going through. The information will guide the creation of strategies to speed recovery and support.

Your individual responses will not be published. Responses will be analyzed to determine the extent of economic impact locally and region-wide. General results will be published; all respondents will receive the findings and updates regarding economic assistance opportunities.

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* 1. Business or organization name

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* 2. Business Address

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* 3. Additional locations (The following survey questions pertain to your Wadsworth location only.)

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* 4. Your contact information

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* 5. Primary product or service

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* 6. Organization type

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* 7. Ownership (Check all the apply)

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* 8. Number of employees in your businesses from the options below:

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* 9. Please indicate your gross revenues in 2019 from the options below:

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* 10. Which industry sector best describes your business? (Check all that apply)

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* 11. Have you reduced your staffing capacity?

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* 12. What is the number of full-time/part-time employees you had before COVID-19 and you have now?

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* 13. Do you anticipate reducing staffing in the future?

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* 14. Will you be able to make your rent or lease payments on your property and/or equipment or debt?

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* 15. How much has your gross income declined compared to this month last year?

100% Lower 50% Lower No Change
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i We adjusted the number you entered based on the slider’s scale.

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* 16. How much will your gross income decline next month (compared to the same month last year)?

100% Lower 50% Lower No Change
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i We adjusted the number you entered based on the slider’s scale.

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* 17. Please indicate which additional impacts your business is experiencing. (Check all that apply)

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* 18. Please indicate which of the following COVID-19-related developments has affected your business (Check all that apply)

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* 19. Have you applied or do you plan to apply for any COVID-19 relief programs? Please check any that apply.

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* 20. If you applied for any COVID-19 relief programs, have you received your financial assistance?

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* 21. Do you think financial relief passed by the federal government has been sufficient?

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* 22. Have you been able to obtain Personal Protection Equipment (PPE) in order to run your business?

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* 23. How worried are you about your business or organization surviving this challenge?

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* 24. What else would you like us to know? What assistance does your business or organization need?

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