Please note, each survey submission should be based on the business LOCATION, not the business entity.

For example, if your business has multiple store fronts, sites or offices, a survey should be submitted for EACH LOCATION in Delaware County.

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* 1. Please fill in your contact information. 

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* 2. Which of the following actions, if any, is your organization planning to take to encourage employees to get a COVID-19 vaccine once they are readily available? (check all that apply)

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* 3. Are you currently tracking and encouraging your employees to get the COVID-19 vaccine?

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* 4. How many people are on your payroll?

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* 5. Can you estimate the number of employees that have been vaccinated?

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* 6. Once vaccines are readily available and more employees return to the physical workplace, to what extent is your organization concerned about providing reasonable accommodations to those who cannot or who refuse to get vaccinated?

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* 7. Would you be interested in hosting or participating in a Pop-Up Vaccine Clinic at or near your business?

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* 8. Would you prefer this is exclusive to your business only?

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* 9. If you answered yes to the previous question, please provide the contact information for the person we should coordinate scheduling this with.

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* 10. How many employees do you anticipate would receive shots at the Pop-Up Vaccine Clinic?

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* 11. If you answered yes to the previous question, please select the days of that week that would work to schedule a Pop-Up Vaccine Clinic? (Check all that Apply)

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* 12. What time of day would work to schedule Pop-Up Vaccine Clinic? (Check all that Apply)

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* 13. If applicable, would you be willing to offer a discount to vaccinated patrons as a County-Wide initiative to encourage herd immunity?

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* 14. Would you be interested in being identified as a 100% Vaccinated Employer (if applicable)?

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* 15. Which of the following describes your organization’s current plans for bringing employees who have been working remotely back to the physical workplace? (check all that apply)

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* 16. Which of the following COVID-19 precautions, if any, does your organization intend to put or keep in place even after vaccines are readily available? (check all that apply)

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* 17. Is your organization currently, or do you plan to, provide employees with access to COVID-19 testing before they enter, or at, the workplace?

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* 18. How did you hear about this survey?

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