DFW Service Industry: Job & Wage Loss Survey

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First name *

Last name *

Age *

Email *

Address *

Phone number *

I work(ed) at a *

Restaurant

Bar

Coffee Shop

Hotel

Other:

The name of my workplace *

The city my workplace is in *

My workplace is now *

Completely closed

Offering curbside pickup / delivery

Limited Seating and/or Reduced Hours

Other:

Employment status *

I was laid off

I was furloughed

My pay was reduced by 30% or less

My pay was reduced by 30% or more

Other:

My position was *

Line Cook

Prep Cook

Host

Bartender

Bar Back

Server

Server Assistant / Busser

Chef / KM

Other FOH Manager

Barista

General Manager

Assistant General Manager or Assistant Manager

Other:

My weekly take home pay (after taxes) was *

Do tips make up more than 50% of your income? *

Yes

Did you have more than one job? *

Yes

Yes, and they were both/all in the service industry

Approximately how many others at your workplace lost their jobs or had their pay cut in a similar way? *

Do you have health insurance (though a spouse, yourself or other means?) *

Yes

My insurance is/was tied to my employer

Other:

What is your current living situation? *

I live alone

With a roomate(s)

With a spouse/partner

With my family — parents/siblings

With my family — partner and/or children

Other:

Did anyone else in your household also have their employment affected by the crisis? *

Yes

Does your household have enough food for the next month? *

Yes

No, because of finances

No, because of low retailer stock

Other:

How long can you go without receiving a paycheck before running out of personal financial resources? (before you have to borrow money, etc.) *

One to two weeks

Three to four weeks

Four to six weeks

Two to three months

More than three months

Other:

What are you concerned with not being able to access/afford the most? *

Have you applied for any government assistance programs (unemployment, food stamps, etc.)? *

Yes

Other:

What date did your employment status change? *

YYYY

Outside of financial stressors, how has this crisis affected you?

Can we add you to a list of community members interested in sharing more of their personal experience (interviews, follow-up surveys)?

Yes

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