Coronavirus (COVID-19) Business Survey
RequiredRequired Question(s)
How is COVID-19 affecting your business?  Your responses will help us shape assistance packages. 

We hope that you are all safe through this pandemic. As this is an unprecedented situation, we are reaching out directly to find out how you are doing, what issues are affecting you most, and finally, if you are able to provide a helping hand, if needed. Your answers to this short survey will help shape government and other assistance packages.  Thank you!
Required 1.
Contact Information:

First Name:
Last Name:
Company Name:
City, State:

Required 2.

Current Number of Employees in your Louisiana location (s):


50 characters left.
Required 3.
How is your business being impacted by the COVID-19? (select all that apply)
Supply chain disruptions
Increase in consumer demand for certain products
Decrease in consumer demand for certain products
Event cancellations / order cancellations
Concern about ability to retain skilled workers
Concern about workforce becoming ill
Watching spending closely due to uncertainty
Need to adjust work schedules and locations
Technology upgrades / changes
Changes to travel / meetings / conferences
Anticipate canceling or postponing an expansion project
No direct impact
Required 4.
*3. How long will your business be able to sustain itself, given the current pandemic and its impact on your business?
Already shut down and need immediate assistance
1 - 2 weeks
3 - 4 weeks
2 months
3 months
4 months or more
How is your business adjusting operations?
Increasing online presence
Delivery changes
Changes in hours of operations
Remote work

How much funding (loans and grants) would you need in order to remain operational beyond that period that you selected above?

0 - $49,999
$50,000 - $99,999
$100,000 - $199,999
$200,000 - $399,999
$400,000 and above
Required 7.
In order to help with the pandemic response, are there parts, services, or technologies that you already make or can supply (even by tweaking your current production/supply chain)? SELECT ALL that you can make/supply:
Cotton swabs with long sticks
Endotracheal tubes; falcon tubes
Food and related products surpluses
Gowns, beds, sheets, gloves, protective suits, over the shoe booties
N95 maks
Printing of pamphlets/brochures/m-
edical kits
Sanitizing/industrial hygiene supplies
Translation services
Ventilators; respirators
RAPID PCR Test kits
Vital sign monitors
Do you deliver using your own trucks or dedicated local truckers?   If yes, can they be made available for local food and medical supplies deliveries?
Yes, and our trucks/services ARE available to help.
Yes, but our trucks/services are NOT available to help.
No, we don't have our own trucks or dedicated local truckers.
Would laid-off staff be interested in working temporarily in other areas (e.g. food distribution)?
Not Sure
Does Not Currently Apply
Required 10.
What help will your business need to continue operations?

350 characters left.
Do you want us to contact you directly?
If you answered Yes to the question above, who should be the point of contact for any follow-up/clarification requests?

Please enter Name, Phone Number & Email

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If we missed anything, please add additional comments.

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