COVID-19 - Dodge County Business Impact Survey
RequiredRequired Question(s)
Required 1.

Business Name:

 

50 characters left.
2.

Industry Type:

Retail or Service
Agriculture
Healthcare
Manufacturing
Transportation & Distribution
Construction
Other  
3.

Describe the current status of your business:

Fully Operational
Temporarily Closed
Permanently Closed
Limited Operating Conditions
Other  
  • Comment:

  • 500 characters left.
4.

Please provide an update to the current operations:

Fully staffed with employees working from home
Fully staffed with employees working on location
Reduced staff with employees working from home
Reduced staff with employees working on location
Other  
  • Comment:

  • 500 characters left.
5.

How many employees did you have before March 1st, 2020?

 

50 characters left.
6.

How many employees do you have now?

 

50 characters left.
7.

Before March 1st, 2020, what were your plans for employees?

Hiring
No Change
Reducing
8.

After March 1st, 2020, what are your plans for employees now?

Hiring
No Change
Reducing
9.
If applicable, what positions are you hiring for?
 

1000 characters left.
10.

Would you like your positions promoted on the Fremont Here We Grow Facebook page?

Yes
No
N/A
11.

Have you applied for any business-related loans or grants?

Yes
No
12.

If applied, were you successful in obtaining funds?

 

50 characters left.
13.

How much has the COVID-19 crisis impacted your revenue since March 1st, 2020?

No change
Increased in revenue
Decreased 1-25%
Decreased 26-50%
Decreased 51-75%
Decreased 76-100%
14.

Would you be open to connecting via Zoom for a Business Retention visit with Stephanie Schurkamp, Director of Business Services to discuss further? If so, please provide contact information below:


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

15.

Additional comments:

 

350 characters left.