Responding through COVID-19

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* 1. Which of the following categories best describes your business industry?

Natural Resources and Mining

Construction

Manufacturing

Wholesale Trade

Retail Trade

Transportation and Warehousing

Utilities

Finance and Insurance

Real Estate and Rental and Leasing

Professional and Business Services

Educational Services

Health Care and Social Assistance

Leisure and Hospitality

Other (please specify)

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* 2. How many total employees are in your company?

Under 10

10 to 20

20 to 50

50 to 100

100 to 150

150 to 500

500 to 1000

1000 to 5000

5000 or more

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* 3. On a scale of 1-10 (1 low – 10 high) please indicate the severity of the impact being felt on your operations due to COVID-19. “Impacts” can include business activity, revenue change, employee sick-time, etc.

1 - Low

10 - High

1 - Low

10 - High

Please elaborate:

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* 4. Do you anticipate making significant changes to your workforce?

Yes

Please elaborate:

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* 5. Does your business need support to maintain normal operations?

Yes

Please elaborate:

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* 6. Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number