Subject to: OMB Control #0693-0078; Expiration Date: 07/31/2019 (NIST Generic Clearance for Community Resilience Data Collections)
Date: ______________________ Surveyor(s): _______________________
PIN: _________________ Business Name: ____________________
Address : ___________________________________________________________
Result Completion Code: ______
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4. hard refusal |
7. incomplete/partial |
10. no answer or response, but evidence/confirmation operating |
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8. non-operational business – closed BEFORE event |
11. no access (e.g., fence preventing entry) |
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9. non-operational – closed AFTER event / destroyed |
12. ineligible, business (name) different than the one expected |
What is the operational status of this business?
Open
Permanently closed
Moved to alternative location (provide address:______________________________)
Not sure/don’t know (take notes on any information that can help us identify the status of the business: _____________________________________________________________ )
What event did this location experience? [Hazard Type] [associated “name”]
[Take photo of outside of business with geocoding]
(The following questions should be answered by business owner or manager. The questions in this servey relate only to this particular lcation for this business.)
What is your role with this business? 1. Owner 2. Manager 3. Owner and Manager
Did you undertake any advance preparation/activities to prepare for potential hazards? 1. Y 2. N
5.1. If Y, please describe the specific actions or investments: _______________________________
__________________________________________________________________________________
What kind of physical damage was caused by the event and how severe was the damage? [refer to separate business damage states table]
Building damage |
1. None 2. Minor 3. Moderate 4. Severe 5. Complete |
Contents/inventory damage |
1. None 2. Minor 3. Moderate 4. Severe 5. Complete |
Machinery/equipment damage |
1. None 2. Minor 3. Moderate 4. Severe 5. Complete |
Important (hard copy) documents? |
1. None 2. Minor 3. Moderate 4. Severe 5. Complete |
Record height of water mark if applicable (ask owner/manager to point to place on the wall where water reached) |
_____ inches |
What types of utilities and services were disrupted at this building? And for how long?
(* N/A: not applicable, if your business does not use this service, please indicate N/A; DK: don’t know)
1. Yes 2. No 3. DK 4.
N/A
____ Hours or _____
days still don’t have electricity electric power? |
If YES, how long until it was fully repaired? |
1. Yes 2. No 3. DK 4.
N/A
____ Hours or _____
days still don’t have water water? |
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1. Yes 2. No 3. DK 4.
N/A natural gas? |
____ Hours or _____
days still don’t have natural gas |
1. Yes 2. No 3. DK 4.
N/A sewer? |
____ Hours or _____
days still don’t have sewer |
1. Yes 2. No 3. DK 4.
N/A
____ Hours or _____
days still don’t have landline
landline phone? |
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1. Yes 2. No 3. DK 4.
N/A
____ Hours or _____
days still don’t have cell phone cell phone service? |
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1. Yes 2. No 3. DK 4.
N/A Internet access? |
____ Hours or _____
days still don’t have internet/IT |
1. Yes 2. No 3. DK 4.
N/A IT (e.g., access to Critical computer Programs/data) ? |
____ Hours or _____
days still don’t have IT |
1. Yes 2. No 3. DK 4.
N/A experience any accessibility issues? |
____ Hours or _____
days still don’t have full
accessibility
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[If yes to loss of electric power] Did this business use a backup generator? 1. ___Yes 2. ___No
[If yes] how long was the backup generator used? _____ days
[If yes to loss of water] Did this business have backup water supply? 1. ___Yes 2. ___No
[If yes] how long did the backup water supply last? _____ days
Any other backup systems used besides generators or water supply? 1. ___Yes 2. ___No
[If yes] please describe _________________________________________________
Please add any information about damages from loss of power or other utilities (e.g., leading to inability to move perishable inventory or moisture/mold damage). ____________________________________
_________________________________________________________________________________________
Was there a stoppage or delay in the delivery of supplies that interrupted business activities (e.g., production or sales)? 1. Yes 2. No 3. N/A If yes, for how long ? _______
If yes: Was this a complete or partial stoppage? 1. Complete 2. Partial; Time: ______ (days)
Did the business experience any other supply chain issues; please explain briefly: ________________________________________________________________________________________________________________________________________________________________________
Immediately following the event, operations were at:
1. 100% (fully functioning) 2. 80-99% 3. 50-79% 4. 30-50% 5. 1-29% 6. 0% (operations completely ceased)
How long did it take for your business to resume operations? ____________ (days)
Did you make the decision to close the business prior to the event? 1. Yes 2. No
If yes [Q12], please answer the following:
When did the business make the decision to close (e.g., 1 day, 1 hr. before the event hit)? ___
What prompted the closure?
What information was used to make this decision? _________________________________________
______________________________________________________________________________________
If no [Q12], please answer the following:
When during or after the event did the business close?
Was it a required closure because it could not function given damage?
Who made the final determination? 1. Owner 2. Manager 3. Local policy/requirement 4. Other ______
What information was used to make this decision? _________________________________________
______________________________________________________________________________________
Did you use any of the below graphical information when tracking the storm and deciding whether or not to close? 1. Y 2. N
If no[Q15], please answer the following: If you didn’t use any of the above information, where did you get your information? (list all that apply)
local network tv news b. National TV c. Weather Channel d. Accuweather e. Local government,
f. Community leaders g. radio h. internet source i. friends/family j. social media k. OTHER _____________
Did this business experience a loss of customers? Please think about this question in the context of immediately pre-event to when operations (above 0%) began again at the location
1. Lost customers (_____% loss) 2. Remained the same 3. Gained customers (___% gain of customers)
How did the business communicate the status of the business (e.g., open or not) to potential customers and the public? 1. Telephone 2. E-mail 3. Text message 4. Social media 5. Other _____
How dependent is this business on this physical location? (In other words, can this business use virtual location(s) or service(s) during recovery):
Not dependent on physical location at all
Somewhat dependent on physical location
Extremely dependent on physical location
How might the experience of this event change your approach to planning for a next storm?
Had this business experienced any small or large-scale disaster effects previously? 1. Y 2. N
Specify type (natural, human-made) and time period: __________________________________________________________________________________________________________________________________________________________________
How long did it take after the event for employees to access this work location? ____ (days)
Was there an alternate work location available for employees to work while the primary location was closed? 1. Yes 2. No
If [22.1=yes] How far away was the alternate work location from the primary location? ____ (mi.)
If [22.1=yes] What type of location was used: 1. Another physical location owned by the business 2. Third-party provided location 3. Employee’s home
Did employees have to spend extra hours at work (before/after/during) the event? 1. Yes 2. No
Were any employees present at the work location during the event? 1. Yes 2. No
How did the business communicate the status of the business and their work schedule to employees? 1. Telephone 2. E-mail 3. Text message 4. Social media 5. Other _____
Was there any communication plan in place and was it part of training for employees?
Did your business experience any issues with employees’ ability to report to work (once you began operation post-event)?
26.1. Employee(s) could not report to work due to transportation problems? 1. Y 2. N
26.2. Employee(s) could not report to work due to the need to fix house? 1. Y 2. N
Employee(s) could not report to work because their children not yet back to school? 1. Y 2. N
Employee(s) could not report to work due to disaster-related physical health issue? 1. Y 2. N
Employee(s) could not report to work due to disaster-related mental health issues? 1. Y 2. N
Are you aware of any employee long-term health effects arising from the event (e.g., cardiovascular disease, mobility issues)? 1. Y 2. N
In which year was this business established at this location? ____ ___ (Year)
What is your primary line of business?
Construction
Manufacturing
Retail trade
Service
Other (please specify): _______________________________________
Before the hazard event, how many full time and part time employees did this business have? And now?
Before: Full time __________ Part time ____________
Now: Full time __________ Part time ____________
Does this business own or rent the building?
Own (including buying the building with mortgage) 2. Rent 3. Other _________________________
What was the business ownership structure before the [event]?
Single owner
Partnership (multiple owners)
Corporation or franchise
Cooperative
Other (please specify): __________________________________
Compared to before the hazard event, what is the % capacity at which the business is operating today? ______ %
(For “capacity,” consider aspects of the business that are most important to you, like the quality and/or quantity of service or product offerings. For example: 50% for reduced capacity, 110% for increased capacity, or 0% for businesses that have not resumed operations.)
How has the business revenue changed since the [event]? (Please reference gross revenue.)
1. Decreased greatly
Decreased
Stay the same
Increased
Increased greatly
How profitable was your business before the [event]? What about now?
Before |
Highly profitable Profitable Breaking even Unprofitable Highly unprofitable closed |
Now |
Highly profitable Profitable Breaking even Unprofitable Highly unprofitable closed |
Where do you feel your business is in the process of recovery today?
Still in operation but will never recover (please explain) _______________________________
Still in survival/response mode
Recovering
Mostly recovered
Fully recovered
Please indicate your level of agreement with the following statements.
We now service more customers outside our city than we did before the disaster |
2.
Disagree 3. Neutral 4. Agree
disagree agree |
We now have more suppliers outside our city than we did before the disaster |
2.
Disagree 3. Neutral 4. Agree
disagree agree |
Did your business have any type of documented plan (e.g., business continuity plan, disaster plan, etc.) to guide your actions through the hazard? 1. Yes 2. No
[If 38=”Yes”] Do you feel the plan enabled you to recover your operations more quickly than if you had no plan? 1. Yes 2. No 3. D/K
[If 38=”Yes”] Have you updated your plan with the lessons learned from this event? 1. Yes 2. No 3. D/K
[If 38=”No”] If you had no plan prior to this event, are you developing a plan now (or in the near future) based on the lessons learned from this event? 1. Yes 2. No 3. Maybe
Did you have insurance coverage related to this disaster type on the building, contents, or business interruption before the event?
Did you file claims and receive money?
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Required to have insurance? |
Had Insurance? |
Filed Claim? |
Received Money? |
Received When? (months after event) |
% insurance covered |
Building |
1. Yes 2. No |
1. Yes 2. No |
1. Yes 2. No |
1. Yes 2. No 3. pending |
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Content (business insurance/most relevant to renters) |
1. Yes 2. No |
1. Yes 2. No |
1. Yes 2. No |
1. Yes 2. No 3. pending |
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Business interruption |
1. Yes 2. No |
1. Yes 2. No |
1. Yes 2. No |
1. Yes 2. No 3. pending |
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Did you receive any of the following assistance in recovery?
Assistance Description
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Applied? |
Received? |
Received When? (months after event) |
a. FEMA financial assistance |
1. Yes 2. No |
1. Yes 2. No |
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b. SBA (Small Business Administration) loan |
1. Yes 2. No |
1. Yes 2. No |
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c. Other federal or state funds (specify): ______________________________________ |
1. Yes 2. No |
1. Yes 2. No |
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d. Local government funds (specify): ______________________________________ |
1. Yes 2. No |
1. Yes 2. No |
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e. Financial assistance from any church or other NGOs (non-government organizations)? |
1. Yes 2. No |
1. Yes 2. No |
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f. Clean up or repair help from church or other NGOs? |
1. Yes 2. No |
1. Yes 2. No |
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g. Private/bank loans |
1. Yes 2. No |
1. Yes 2. No |
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h. Crowdsourcing online? |
1. Yes 2. No |
1. Yes 2. No |
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i. Fundraisers (in-person/not online)? |
1. Yes 2. No |
1. Yes 2. No |
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j. Other(s)? _____________________ |
1. Yes 2. No |
1. Yes 2. No |
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What assistance did you need and not get? (monetary or in-kind): ____________________________
______________________________________________________________________________________
How long do you estimate this business could function in a deficit (days, weeks, months)? _______
What are your thoughts today about the risks to your business by extremes precipitation and/or temperature and your interest in undertaking mitigation options? ____________________________
________________________________________________________________________________
How many years have you worked as a business owner/manager?
At this location: _____________ (years)
In your total career: _____________ (years)
What is your age? ________________ (years)
What is
your number of years of schooling? Enter number of years
_______ and indicate
type of diploma or degree: 1. Some
high school, but didn’t finish 2. Completed High School 3.
Some college, but didn’t finish, 4. Associate degree 3.
Bachelors 4. Masters or higher degree
Are you Hispanic? 1. Yes 2. No
What is your race? Select one or more (check all relevant)
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What is your household income? (per year before taxes)
Under $25,000
$25,000-$39,999
$40,000-$59,999
$60,000-$79,999
$80,000-$99,999
$100,000-$124,999
$125,000-$149,999
Over $150,000
If you have any comments about the survey and/or business recovery after the [event], please let us know verbally or write them in the space below.
THANK YOU VERY MUCH FOR COMPLETING THE SURVEY!
This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of information displays a currently valid OMB control number. For this collection, the OMB Control number is:0693-0078 with an expiration date: July 31, 2019. Public reporting burden for this collection is estimated to be 15 minutes per survey, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the National Institute of Standards and Technology, Attn: Dr. Jennifer Helgeson, NIST, 100 Bureau Drive, MS 8603, Gaithersburg, MD 20899-1710, telephone 301-975-6133, or via email: jennifer.helgeson@nist.gov.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | yu Xiao |
| File Modified | 0000-00-00 |
| File Created | 2021-01-16 |