COVID-19 Economic Impact Survey This is not an application for assistance This survey is for data collection to better understand the needs of the Madison County business community. This data will enable us to better advocate for additional resources to help our local economy during this pandemic. OK Question Title * 1. Contact Information Name Company City/Town Email Address Phone Number OK Question Title * 2. Do you own or rent your business space? Own Rent OK Question Title * 3. Has your business suffered economic damage as a result of the COVID-19? Yes No OK Question Title * 4. As of today, what is your estimated inventory loss? OK Question Title * 5. Are these losses covered by insurance? Yes No OK Question Title * 6. As of today, what is your estimated revenue loss? OK Question Title * 7. Are these losses covered by insurance? Yes No OK Question Title * 8. What is your total number of employees? 1-5 6-10 11-20 21-50 51-100 100+ OK Question Title * 9. Have you had to make layoffs or furloughs? Yes No OK Question Title * 10. If yes, how many employees have been affected? OK Question Title * 11. What status do these employees carry? Full Time Part Time Seasonal Contractual Other (please specify) OK Question Title * 12. Are you covering healthcare costs for impacted employees? Yes No Other (please specify) OK Question Title * 13. What are your current business needs? Payroll assistance Gap Funding Supply Chain Stability Personal Protective Equipment - PPE Healthcare Assistance Other (please specify) OK Question Title * 14. What do you anticipate your needs being in 30 days? OK Question Title * 15. Your business is currently operating at what level? Open without restrictions Closed due to shutdown Open with mandated modifications Other (please specify) OK Question Title * 16. What types of assistance would be most helpful to your business? Immediate Guidance on how to modify by business model Technical training on social media How to protect my employees from COVID-19 How to protect my customers from COVID-19 Information on financial assistance over the next 90 days Information on costs and risks of starting new services like delivery and e-commerce Other (please specify) OK Question Title * 17. If business disruption continues at the current rate, how soonwill your business be at risk of closing permanently? Less than 2 weeks Less than a month 1-2 Months 3-5 Months More than 5 months Not a concern OK Question Title * 18. If offered, would you be interested in training sessions aimed at modifications that could make your business more resilient to future pandemics? Yes No OK Question Title * 19. Additional Comments OK DONE
