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Winter Storm – Short Survey
Please complete the short survey to let us know your personal situation.
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* Indicates required question
Your Name
*
Your answer
The Department You Work In
*
Your answer
Your Employee ID Number
*
Your answer
Phone Number We Can Reach You
*
Your answer
Personal Email Address
Your answer
1)
Given the winter storm situation, please let us know that you and your immediate family are doing fine?
*
Yes
No
2)
What type of assistance or help do you need from the company?
Plumbing
Groceries
Water
Medical Supplies
None
Other:
If you answered "Other" to question 2 above, please provide more information below.
Your answer
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