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Disaster Recovery Business Assessment
* Indicates required question
Email
*
Your email
Date of Survey
*
MM
/
DD
/
YYYY
Company/Business
*
Your answer
Address
*
Your answer
Company Contact Name
*
Your answer
Company Contact Email
*
Your answer
Company Contact Phone
*
Your answer
What type of business do you own?
*
Hotel
Campground
Resort
Restaurant
Service
Transportation
Manufacturing
Wholesale
Fishing
Tours
Retail
Real Estate
Other:
How is your business doing right now?
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Poor (Slow)
Fair (Steady)
Good (Increasing)
How well was your business doing before the hurricane, as compared to now?
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Worse
Better
No Change
How well do you think your business will do in the next year?
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Worse
Better
No Change
How long has your business been open?
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Less than 1 year
1-3 years
3-5 years
6-10 years
10 years or more
What happened to your business during the hurricane and right after?
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Stayed open, but structure was damaged
Stayed open, but contents or customer area was damaged
Closed, with damage to the structure
Closed, with damage to contents or customer area
Closed, with lack of access for employees, customers, or suppliers
No major damage
Other:
Required
How long was your business closed after the hurricane?
*
We did not close
Less than 1 week
1-2 weeks
3-4 weeks
1-2 months
More than two months, if so how long? (please specify below)
We are still closed
Business has permanently closed
Other:
Was there any damage to the structure, building, or inventory of your business?
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Yes
No
Which areas of your business were physically damaged?
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Structure/foundation
Inventory/product
Equipment/office/assets
None
Other:
Required
Have you been able to receive enough materials, supplies, and services since the hurricane?
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Yes
No
What damage to the surrounding area has made it difficult for your business to stay open or reopen?
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Roads and transportation
Telephone lines or cell service
Access to housing/shelter
Access to fresh water
Access to electricity
Access to internet and/or cable
Other:
Required
Where are you getting funds from to help with business repairs?
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Business savings (retained earnings)
Banks loan(s)
Loan(s) from family or friends
Disaster Assistance Loan (please specify below)
FEMA Program Property
EDA-funded Revolving Load Fund (RLF)
Insurance (business interruption or flood)
Line of credit
Self-insured
Community donations
Other financing (please specify below)
Other:
Required
What do you need help with right now?
*
Figuring out my options
Determining financial needs
Operating expenses under $10,000
Operating expenses between $10,00 and $25,000
Operating expenses over $25,000
Deciding how to revuild my business
Deciding if my business should stay open
Deciding if my business shoul reopen
Physical help to repair my business
Finding a new location for my business
Problems with workforce
New marketing plan
Reaching/contacting clients
None of the above
Other:
Required
Will you need help applying for any of the following assistance?
*
Figuring out my options
Determining financial needs
Operating expenses under $10,000
Operating expenses between $10,00 and $25,000
Operating expenses over $25,000
Deciding how to revuild my business
Deciding if my business should stay open
Deciding if my business shoul reopen
Physical help to repair my business
Finding a new location for my business
Problems with workforce
New marketing plan
Reaching/contacting clients
None of the above
Other:
Required
Do you have business insurance?
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Yes
No
Does your business insurance cover loss of income?
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Yes
No
Unknown
I do not have business insurance
Does your business insurance cover losses from flooding, hurricanes or other natural disasters?
Yes
No
Unkown
I do not have business insurance
Clear selection
How many people work for your business right now?
*
Your answer
How many people worked for your business before the hurricane?
*
Your answer
How many of your employees were affected negatively by the hurricane?
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Your answer
How many of your employees have moved away due to the hurricane?
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Your answer
Do you know if your employees are planning to return?
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Yes
No
Some of them
If your business is interested in providing services/products to help others with recovery, what are you business' capabilities/qualifications/certifications?
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Financial assistance
Free respite services
Long-term/short-term housing
Healthcare services
Business/flood insurance
Volunteer/donation services
Business/transactional law firm
Communication services
Commercial/residential construction
Meal services
Surveying/engineering services
Other:
Required
May we contact you for more information if it is needed?
*
Yes
No
Do you have any other comments?
Your answer
Send me a copy of my responses.
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