Coronavirus Preparation Survey
Name
*
First Name
Last Name
Do you have TeamViewer installed on your work computer?
*
Yes
No
What parts of your job duties could you easily accomplish from home?
*
What other things could you accomplish without physically being at the office?
*
If we close the offices would you like to:
*
Work from home
Use vacation/sick time (if available)
Collect unemployment (if available)
All of the above
Questions about your home
Do you have a desktop computer or laptop? (Do not include an Ipad or other tablet)
*
Yes
No
Do you have an Ipad or other tablet?
*
Yes
No
Do you have high speed internet?
*
Yes
No
Do you have a landline? (house phone)
*
Yes
No
Do you have reliable cell phone service at your home?
*
Yes
No
What is the phone number?
*
Do you have a designated office area or a suitable/ quiet area to work?
*
Yes
No
If applicable, do you have access to daycare?
*
Yes
No
Not applicable
Submit
Should be Empty: