Disaster Recovery Business Assessment
Email address *
Date of Survey *
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/
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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? *
How is your business doing right now? *
How well was your business doing before the hurricane, as compared to now? *
How well do you think your business will do in the next year? *
How long has your business been open? *
What happened to your business during the hurricane and right after? *
Required
How long was your business closed after the hurricane? *
Was there any damage to the structure, building, or inventory of your business? *
Which areas of your business were physically damaged? *
Required
Have you been able to receive enough materials, supplies, and services since the hurricane? *
What damage to the surrounding area has made it difficult for your business to stay open or reopen? *
Required
Where are you getting funds from to help with business repairs? *
Required
What do you need help with right now? *
Required
Will you need help applying for any of the following assistance? *
Required
Do you have business insurance? *
Does your business insurance cover loss of income? *
Does your business insurance cover losses from flooding, hurricanes or other natural disasters?
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? *
Your answer
How many of your employees have moved away due to the hurricane? *
Your answer
Do you know if your employees are planning to return? *
If your business is interested in providing services/products to help others with recovery, what are you business' capabilities/qualifications/certifications? *
Required
May we contact you for more information if it is needed? *
Do you have any other comments?
Your answer
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