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Independent Restaurant COVID19 Impact Survey
The following is a survey for local restaurant and bar operators intended to gather information to help the Independent Restaurant Coalition continue to show Congress why and how the industry is hurting as well as the necessity of replenishing the Restaurant Revitalization Fund.

Please note, personally identifiable information will not be shared publicly. At the end of this form, you can answer yes if we have your permission to contact you for follow-up, or use the information you provide in testimonials that we publish to social media or share with reporters.
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First name
Last name
Email address
Business name (personally identifiable information will not be shared publicly) *
City (personally identifiable information will not be shared publicly) *
State (abbreviation e.g. NY) (personally identifiable information will not be shared publicly) *
Is your business still open? *
Have you received financial assistance from any of the programs listed below? (Check all that apply) *
Are you in danger of, or have you filed for, bankruptcy protection? *
Have you received, or do you anticipate receiving an eviction notice in 2022? *
Are you in danger of permanently closing your business in 2022? *
How many restaurants/bars have you had to close permanently close in the last two years? *
or more
Did COVID force changes to your hours of operation during the month of December 2021? *
If you answered yes to the question above, how many days were your hours of operation impacted in December 2021? *
How much would you estimate the Omicron variant decreased your anticipated sales in December 2021? *
How much would you estimate the effects of the pandemic (reduced hours of operations, paid sick leave, cancelled parties & reservations, etc.) have impacted your bottom line since the crisis began (e.g. what has the cumulative impact been from Feb 2020 to today)? *
How many people do you currently employ? *
How many people did you employ in February 2020? *
Did you have difficulty hiring staff in 2021? *
Have you been forced to lay off staff in the last 60 days because of a lack of sales or COVID related closure? *
Check all that apply regarding COVID testing *
How much do you spend per week on COVID tests for staff? *
Check any of the following that apply since February 2020.
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