Skip to Main Content
Loading
Loading
Government
Departments
Residents
Business
How Do I?
Home
Form Center
A
A
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Building Department/Fire Marshal
City Secretary
Customer Service
Emergency Management
Home Elevation
Nassau Bay Police
Parks & Recreation
By
signing in or creating an account
, some fields will auto-populate with your information.
Business Retention Expansion COVID-19 Business Impact Survey
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Business Retention Expansion COVID-19 Business Impact Survey
The City of Nassau Bay is seeking to understand the impact and identify the needs of local businesses resulting from COVID-19. We are utilizing this survey to gather meaningful data that will help us understand the impacts of the pandemic.
Respondent Information (All responses will be held in confidence)
Name
Company
Address
City / Town
State
Zipcode
Operations & Supply Chain
What percent (%) capacity is your facility operating at?
-- Select One --
0%
<10%
10-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
>100%
What percent (%) capacity are you operating remotely?
-- Select One --
0%
<10%
10-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
90-100%
>100%
Voluntary closure date (MM/DD/YYY)
Voluntary closure date (MM/DD/YYY)
Forced closure date (MM/DD/YYYY)
Forced closure date (MM/DD/YYYY)
Workforce
What is your current total full-time employee count?
-- Select One --
1-10
11-25
26-50
51-100
101-250
251-500
501-1,000
>1,000
What is your current total part-time employee count?
-- Select One --
1-10
11-25
26-50
51-100
101-250
251-500
501-1,000
>1,000
Has your employee count increased due to COVID-19 specifically?
Yes
No
If yes, how many new hires?
Has your employee count decreased due to COVID-19 specifically?
Yes
No
If yes, how many laid off, and/or how many terminated?
What portion (%) of your workforce is currently working remotely?
-- Select One --
0%
<10%
10-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
>100%
What portion (%) of your workforce is unable to work remotely?
-- Select One --
0%
<10%
10-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
>100%
If employees are temporarily not reporting for work, what percentage (%) will be paid during the work hiatus?
-- Select One --
0%
<10%
10-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
>100%
If paid, how many weeks?
Finance
How many weeks of a business slow down or shutdown would you estimate your business could survive before closing?
Future
What are your top three concerns looking forward? (Check up to 3 only)
Decreasing consumer confidence/spending
Financial impact on operations and/or liquidity and capital
Global or U.S. recession
Impact on tax and trade issues
Lack of information for decision making
Lower productivity
Supply chain disruptions
Workforce reduction
Employee stress
Other (please describe when prompted)
If other, please describe your concern looking forward?
Do you anticipate any permanent reductions in your workforce in the next 3 months?
Yes
No
Unsure
If Yes, what number of reductions do you expect?
Do you anticipate any permanent reductions in your workforce in the next 6 months?
Yes
No
Unsure
If Yes, what number of reductions do you expect?
Are you interested in an SBA Economic Injury Disaster Loan if or when they become available?
Yes
No
By selecting yes, I agree to be emailed more information about SBA Economic Injury Disaster Loans.
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
Government
Departments
Residents
Business
How Do I?
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow