COVID-19 Impact Survey for Businesses
The survey is conducted to report ongoing effects of COVID-19 pandemic on business operations. All information provided will be reported in general terms and kept confidential. Thanks for the participation.
1. What is your current operating status?
Regular Operations
Remote Operations
Reduced Capacity
Halted Operations
Increased Capacity
Other
2. Describe the changes in your operations.
3. Please select your industry.
Entertainment
Government
Healthcare
Insurance
Manufacturing
Media
Non-Profit
Profession Services
Real Estate
Retail
Technology
Transportation
Other
4. Has COVID-19 significantly impacted your business?
Yes
No
5. Please select the impact type.
Convention or Tourism Cancellation
University Closure
Remote Work
Media Production Cancellation
Airport Related Impact
Interrupted or Lost Supplier
Bar/Cafe/Restaurant Closure
Other
5.1. When did the impact start?
 -
Month
 -
Day
Year
Date
5.2. When did/will the impact end?
 -
Month
 -
Day
Year
Date
5.3. Estimated revenue for above-mentioned period.
5.4. Revenue during the same period of the prior year.
5.5. How many people did you employ prior to COVID-19?
5.6. How many people do you employ after COVID-19?
6. Does your business have the ability to work remotely?
Yes
No
7. Were your employees being paid when they were not working temporarily because of the pandemic?
Yes, wages were fully paid.
Yes, wages were partially paid.
No, wages were not paid.
Other
8. State your concerns except health for your employees.
9. Select the expected level of upcoming impact of pandemic on your business.
Critical - we may be put out of business
High - significant financial effects and decrease in workforce.
Medium - we may encounter with financial effects.
Low - we may affected financially but we are prepared.
10. Does your business participate in international trade?
We export and import.
We export but not import.
We import but not export.
No, the business is within our country only.
11. Select top three government measures that would be helpful during the pandemic.
Financial Programs
Employment Programs
Tax waivers/Temporary tax breaks
Reduction of tariffs
Cash transfers
Other
12. What type of support/information do you need at this time?
Your Name
First Name
Last Name
Company Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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