Coronavirus COVID-19 Business Survey

How is COVID-19 affecting your business? Your responses will help us shape assistance packages.

We hope that you are all safe through this pandemic. As this is an unprecedented situation, we are reaching out directly to find out how you are doing, what issues are affecting you most, and finally, if you are able to provide a helping hand, if needed. Your answers to this short survey will help shape government and other assistance packages. Thank you!

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* 1. Contact Information:

Name:

Company:

Email:

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* 2. Current Number of Employees in your NYC Location(s) (Answer required):

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* 3. How long will your business be able to sustain itself, given the current pandemic and its impact on your business? (Answer required)

Already shut down and need action now

1 - 2 weeks

3-4 weeks

2 months

3 months

4 months or more

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* 4. How much funding (loans and grants) would you need in order to remain operational beyond that period that you selected above?

0 – $49,999

$50,000 – $99,999

$100,000 – $199,999

$200,000 – $399,999

$400,000 and above

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* 5. In order to help with the pandemic response, are there parts, services, or technologies that you already make or can supply (even by tweaking your current production/supply chain)? SELECT ALL that you can make/supply:

Cotton swabs with long sticks

Endotracheal tubes; falcon tubes

Food and related products surpluses

Gowns, beds, sheets, gloves, protective suits, over the shoe booties

N95 masks

Printing of pamphlets/brochures/medical kits

Sanitizing/industrial hygiene supplies

Translation services

Ventilators; respirators

PAPRs

RAPID PCR Test kits

Vital sign monitors

Other (please specify)

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* 6. Do you deliver using your own trucks or dedicated local truckers? If yes, can they be made available for local food and medical supplies deliveries?

Yes, and our trucks/services ARE available to help

Yes, but our trucks/services are NOT available to help.

No, we don't have our own trucks or dedicated local truckers.

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* 7. Would laid-off staff be interested in working temporarily in other areas (e.g. food distribution)?

Yes

Not Sure

Does Not Apply Currently

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* 8. Do you want us to contact you directly?

Yes

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* 9. If you answered Yes to Question 8 above, who should be the point of contact for any follow-up/clarification requests?

Name:

Phone:

Email:

Coronavirus COVID-19 Business Survey

How is COVID-19 affecting your business? Your responses will help us shape assistance packages.

Question Title

* 1. Contact Information:

Question Title

* 2. Current Number of Employees in your NYC Location(s) (Answer required):

Question Title

* 3. How long will your business be able to sustain itself, given the current pandemic and its impact on your business? (Answer required)

Question Title

* 4. How much funding (loans and grants) would you need in order to remain operational beyond that period that you selected above?

Question Title

* 5. In order to help with the pandemic response, are there parts, services, or technologies that you already make or can supply (even by tweaking your current production/supply chain)? SELECT ALL that you can make/supply:

Question Title

* 6. Do you deliver using your own trucks or dedicated local truckers? If yes, can they be made available for local food and medical supplies deliveries?

Question Title

* 7. Would laid-off staff be interested in working temporarily in other areas (e.g. food distribution)?

Question Title

* 8. Do you want us to contact you directly?

Question Title

* 9. If you answered Yes to Question 8 above, who should be the point of contact for any follow-up/clarification requests?

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* 10. If we missed anything, please add additional comments.