COVID-19 (Coronavirus) Business Impact Survey
RequiredRequired Question(s)
1.

Which of the following industries best represents your company?

Amusement & Entertainment
Automotive
Construction / Developers
Consumer Services
Education
Financial
Healthcare
Hotels
Insurance / Real Estate
Manufacturing
Non-Profit
Professional Services
Public Utilities
Publishers / Printers
Radio / TV
Restaurants
Retail
Transportation
Wholesalers / Distributors
Other  
2.

Please indicate the size of your business:

Small (less than 20 employees)
Medium (20 to 49 employees)
Large (50 or more employees)
Required 3.
Please indicate which Chamber(s) of Commerce you belong to, if you currently belong
 

350 characters left.
4.

Have you lost business as a result of the COVID-19 (Coronavirus) outbreak? (please describe)

No Impact
Minimal Loss
Significant Loss
I'm on the verge of losing my business
  • Comment:

  • 500 characters left.
5.

Has the outbreak impacted your operation or supply chain? (please describe)

No Impact
Minimal Impact
Significant Impact
  • Comment:

  • 500 characters left.
6.

Do you anticipate any of the following impacts within the next week? (check as many as apply - please describe)

Investment in advertising
Introduction of new services for take-out/delivery services
Supply chain disruptions
Self-imposed reduction in inventory and/or output of product
Slower sales
Reduced hours of operation
Sick employees
Staff disruptions (pay/remote work/childcare needs)
Employee furloughs
Layoffs
Temporary closure of business
Business loan to bridge gap in paying employees, keeping doors open
Permanent closure of business
Other  
  • Comment:

  • 500 characters left.
7.

Do you anticipate any of the following impacts within the next 30 days? (check as many as apply - please describe)

Investment in advertising
Introduction of new services for take-out/delivery services
Supply chain disruptions
Self-imposed reduction in inventory and/or output of product
Slower sales
Reduced hours of operation
Sick employees
Staff disruptions (pay/remote work/childcare needs)
Employee furloughs
Layoffs
Temporary closure of business
Business loan to bridge gap in paying employees, keeping doors open
Permanent closure of business
Other  
  • Comment:

  • 500 characters left.
8.

What are your immediate needs?

 

350 characters left.
9.

What could help your business deal with the impact of the outbreak?

 

350 characters left.
10.
Please share your contact information with us: (not required)

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com

Thank You For Your Feedback!