Humboldt County Office of Emergency Services COVID-19 Economic Impact Survey
1.
IMPORTANT: Attention Employers. Participation in this survey will have a direct impact on the disaster funding that the County of Humboldt may receive for post-COVID-19 economic recovery and economic resources for the Humboldt 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 Humboldt County due to COVID-19. Please include your revenues and data with best guess year-to-date information at every survey submission, do not include forecasts.  Please update your information on a bi-weekly bases. 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 Humboldt 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 County of Humboldt’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 Humboldt.
2.What is the name of your business?
2.What is your type of business?
3.Please provide the business's contact information:
4.Please provide the business's mailing address:
5.Please provide the business's street address:
6.When did the economic impact start?
7.What is the estimated end date?
8.What were your business's year-to-date revenues during the affected damage period? (understanding that this period is ongoing)
9.What were your business's year-to-date revenues during that SAME period of the prior year? (please be sure to also answer question 8)
10.What is your total COVID-19 pandemic year-to-date revenue loss?
11.Amount of business interruption insurance received or anticipated, if any:
12.Have you had to temporarily lay-off employees?
13.Have you had to permanently lay-off employees?
14.How many people did you employ prior to COVID-19 Disaster?
15.How many do you employ now due to COVID-19 Disaster? (please be sure to also answer question 14)
16.Please provide a brief explanation of what adverse economic effects COVID-19 Disaster had on your business: (with best up-to-date information)
17.Have you had to temporarily close your business due to the COVID-19 Disaster? (due to public safety concerns or shelter-in-place orders)
18.Have you had to permanently close your business due to the COVID-19 Disaster? (you do not anticipate re-opening after COVID-19 Disaster)
19.Did your business suffer any property damage?
20.Estimated dollar loss of real property (building), if owned:
20.Estimated dollar loss of contents:
(includes machinery and equipment, furniture and fixtures, inventory, supplies, leasehold improvements, etc)
20.Estimated dollar loss of insurance recovery expected or received for property damages: