Business Impact Assessment
If your business has been impacted by COVID-19, please complete this form. You may also use this as a way to submit a question to the response team.
**Please feel free to submit this form multiple times with updated information and questions**
The results of this form will be shared with team members from the entities listed above, but will be kept confidential. Aggregate data may be shared with a larger audience, no personal or company details would be included. If you have any specific issues or questions with this form, call (812) 232-2391.
Business and Professional Services
Construction and Engineering
Hospitality and Services
Municipal and Utilities
Real Estate and Housing
What size business do you represent? (Full Time Equivalents)
How has your business been negatively impacted by COVID-19?
Supply chain disruptions
Significant decrease in consumer demands for certain items
Decrease in customer demand
Event cancellations and/or order cancellations
Workforce impacts and uncertainty
Has your business experienced any positive results as a result of COVID-19?
New offerings to solve new problems
No positive results
Have you been forced to lay-off employees and/or reduce hours during the pandemic?
If yes, how many employees have been impacted? (Full Time Equivalents)
Less than 10
If yes, what percentage have returned to work?
Less than 25% have returned to work
75-100% have returned to work
Do you anticipate these lay-offs or reductions to be permanent?
What is your estimated revenue loss due to COVID-19?
Less than $5,000
$5,001 - $25,000
$25,001 - $50,000
$50,001 - $100,000
$100,001 - $200,000
Too early to determine
Without financial assistance, how likely is it that your business will permanently close as a result of COVID-19?
How long do you think it will take for your business to return to pre COVID-19 sales and staffing?
2 years +
Will not return to pre-COVID-19 levels
Are you seeking immediate information? (A team member will follow-up with you in 1 business day)
Financial assistance information
Helping my employees file for unemployment
Paid sick leave requirements and eligibility
Not seeking any specific information at this time
What do you anticipate your long-term needs to be?
Additional questions or concerns you would like to have addressed?
Are you in need of masks for your workers and/or customers?
If yes, approximately how many masks will you need?
Less than 10
More than 100
Do not need masks
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