Business Survey - COVID-19

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* 1. Please enter your business or organizations name

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* 2. Please provide your email

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* 3. How many staff members do you have, full time and part time (detail below)

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* 4. In response to COVID-19, please list your hours through the end of the month (i.e, closures, limited hours)

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* 5. Have you had any structural changes to your business or organization (i.e. layoff's)?

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* 6. If you are a restaurant or retailer providing delivery (or take-out) services, please list details below

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* 7. If you have online shopping available (including gift card purchases), please list details below

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* 8. The State of Pennsylvania and the Federal Government are actively discussing financial programs and assistance for businesses and organizations amid this crisis. Please list your top 3 concerns in order of priority, so that we may share these with our elected officials

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* 9. Please provide your best realistic estimate regarding the length of time your business or organization can sustain a shutdown of this nature, so that we may share these with our elected officials