MBDA (COVID-19) Business Impact Survey - HQ

MBDA COVID-19 Recovery Initiative

A CARES Act Funded Program

U.S. Department of Commerce - Minority Business Development Agency

Operated by M. Gill & Associates, Inc.

Serving Businesses throughout the State of Florida

Free Education, Training and Technical Assistance to Small & Minority Businesses

Please complete and submit this COVID-19 Economic Impact and Buyer/Supplier Matchmaking Survey. We will contact you to assist with your SBA and any other Business Disaster Loan or grant Applications. We will also assist you to address other immediate business recovery needs and connect you with resources and contracting opportunities, as applicable.

Data Confidentiality
The data collected from this survey will not be revealed for individual businesses, but will be used in aggregate form, to determine the overall needs and impact of COVID-19 on Florida's small and minority businesses.

Thank you
M. Gill & Associates, Inc.

Question Title

* 1. Section A: The following questions are designed to capture your level of Economic Injury as a result of the COVID-19 Pandemic.

Provide Contact Information:

Name

Company

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. In which county is your business located?

Question Title

* 3. Are you located in a Rural Community?

Yes

If yes, are you in an Agricultural/Farming Community?

Question Title

* 4. Please estimate percentage of monthly revenue decline as a result of COVID-19, if applicable.

Less than 10%

10-30%

31-50%

51-80%

81-100%

Question Title

* 5. Please describe areas of economic and physical injury due to COVID-19 and/or Civil Unrest.

Loss of Employees

Loss of Inventory

Business Closure

Physical Illness

Mental Stress

Civil Unrest

Other (please specify)

Question Title

* 6. Please select your business industry?

Exporter

E-Commerce

Retail (Grocery / Hardware / Pharmacy / etc.)

Personal Care (barber shop / nail salon / etc.)

Restaurant (Caterers / Food Industries / etc.)

Manufacturing

Construction

Professional Services

Other (please specify)

Question Title

* 7. Does your business practice telework to reduce the spread of COVID-19?

Yes

If yes, please provide a brief description:

Question Title

* 8. As a result of remote customer service or teleworking, have you experienced cyber-attacks including: Identity Theft, Ransomware Viruses, Phishing, Malware and/or Password Attacks, etc.? If so, please provide a brief description below.

Question Title

* 9. Section B: This section is designed to match small/minority/women/veteran-owned businesses with public and private organizations to expedite the national response to COVID-19

Please select a commodity you are seeking to procure or sell.

Disinfectants

Face/Head/Body Protection (e.g. Surgical Masks; Face Shields; Goggles)

Gloves

Hand Sanitizers

Hospital Gowns

Medical Equipment

Medical Supplies

N-95 Face Masks

Thermometers / Thermometer Covers

Ventilators

Logistics / Transportation

3D Printing

Body Bags

Sanitizing Wipes

Other (please specify)

Question Title

* 10. Please select your level of engagement

Public-Sector Purchaser

Private-Sector Purchaser

Supplier Distributor

Manufacturer

Retailer

Service Provider

MBDA (COVID-19) Business Impact Survey - HQ

Question Title

* 1. Section A: The following questions are designed to capture your level of Economic Injury as a result of the COVID-19 Pandemic.Provide Contact Information:

Question Title

* 2. In which county is your business located?

Question Title

* 3. Are you located in a Rural Community?

Question Title

* 4. Please estimate percentage of monthly revenue decline as a result of COVID-19, if applicable.

Question Title

* 5. Please describe areas of economic and physical injury due to COVID-19 and/or Civil Unrest.

Question Title

* 6. Please select your business industry?

Question Title

* 7. Does your business practice telework to reduce the spread of COVID-19?

Question Title

* 8. As a result of remote customer service or teleworking, have you experienced cyber-attacks including: Identity Theft, Ransomware Viruses, Phishing, Malware and/or Password Attacks, etc.? If so, please provide a brief description below.

Question Title

* 9. Section B: This section is designed to match small/minority/women/veteran-owned businesses with public and private organizations to expedite the national response to COVID-19Please select a commodity you are seeking to procure or sell.

Question Title

* 10. Please select your level of engagement

* 1. Section A: The following questions are designed to capture your level of Economic Injury as a result of the COVID-19 Pandemic.

Provide Contact Information:

* 9. Section B: This section is designed to match small/minority/women/veteran-owned businesses with public and private organizations to expedite the national response to COVID-19

Please select a commodity you are seeking to procure or sell.