Bi-monthly Economic Injury Survey - Del Norte County Businesses 5/6-5/19
This form will take approximately 2 minutes and is for Del Norte County Businesses. Please fill out one form for each business you own or manage.

IMPORTANT: Attention Employers. Participation in this survey will have a direct impact on the disaster funding that the Del Norte County may receive for post-COVID-19 economic recovery and economic resources for the Del Norte County business community. Please be sure to state your business name clearly in the first question. This will help analysts maintain the integrity of your data.

The purpose of this survey is to capture current, ongoing, and cumulative data on the total amount of economic loss for businesses in Del Norte County due to COVID-19. This survey is an electronic version of the Disaster Economic Impact worksheet for businesses. Completing this survey will provide data that will be used in the total claim submitted by Del Norte County for disaster relief. Please note that your information will be confidential and not be made public. Data will only shared between essential staff assisting the business community at this time.

We realize as this crisis progresses, you may need to update information. Please go ahead and take the survey again with your same contact information to make updates. Since this survey is designed to be taken multiple times, it is recommended by the Del Norte County’s Office of Emergency Services (OES) to update your submission on a bi-weekly basis during this COVID-19 event. And again, a total amount of economic impact will be submitted to disaster recovery agencies on your businesses’ behalf by the County of Del Norte.
Business Name *
Your answer
Business Owner (Last Name, First Name) *
Your answer
Email *
Your answer
Address *
Your answer
Phone number *
Your answer
Is your business currently open? *
If your business is currently open, in which ways have you changed how your business operates?
Do you need help with navigating:
Do you need help applying for disaster loan relief?
Could you benefit from a business advice/advisor?
Are you experiencing any equipment or supply disruptions?
If yes, what equipment or supply disruptions are you experiencing?
Your answer
On what date did the economic affects of COVID-19 Pandemic first impact your business?
Your answer
What were your business's revenues during the affected damage period of the COVID-19 Pandemic? ($0.00)
Your answer
What were your business's revenues during that SAME period of the prior year? ($0.00)
Your answer
What is your total COVID-19 pandemic gross revenue loss year to date? ($0.00) We understand this will be an estimate.
Your answer
Have had to lay off employees because of the COVID-19 pandemic?
How many people did you employ prior to COVID-19 Disaster?
Your answer
How many do you employ currently? (subsequent to COVID-19 Pandemic)
Your answer
Please provide a brief explanation of what adverse economic effects COVID-19 Disaster had on your business:
Your answer
What are your largest concerns as you look forward to the next 60 to 90 days
Your answer
What critical costs does your business have that would impact being able subsist the next 30-60 days before government funds become available?
What would be the minimum monthly amount (per area identified above) that would allow you to subsist until government funds become available? (ex. Rent $0.00)
Your answer
Amount of business interruption insurance received or anticipated, if any:
Your answer
We understand local businesses are having difficulty accessing CARES Act funds and other financial resources. Please share your experiences below. This information will be confidential and used only to advocate for local business as a whole.
Would you be willing to modify your business in order to help with COVID-19 needs in the community?
Please know........all of this information is kept confidential. This data will only be used to link you to services and the compiled data we be used to acquire economic impact funding for the community. And just remember...
Who filled out this survey.
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