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2021 Flood Survey
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1
Name of Business
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2
Address at Time of Flood
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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3
Type of Business
Brief description of items sold, services offered, or nature of business.
0/300
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4
Employment Totals
Please only input a single number per box. Leave a box blank if it is not applicable to your business.
# Full-Time
# Part-Time
Number of Employees at the time of the Flood
Row 0, Column 0
Row 0, Column 1
Current Number of Employees (if re-opened)
Row 1, Column 0
Row 1, Column 1
Number of Employees at the time of the Flood
Current Number of Employees (if re-opened)
# Full-Time
Row 0, Column 0
# Part-Time
Row 0, Column 1
# Full-Time
Row 1, Column 0
# Part-Time
Row 1, Column 1
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5
Average Hourly Wage of Employees
Please only input a single number per box.
Prior to the Flood
Current Rate
$
Row 0, Column 0
Row 0, Column 1
$
Prior to the Flood
Row 0, Column 0
Current Rate
Row 0, Column 1
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6
Did your business reopen?
YES
NO
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7
How long were you closed?
Please only input a single number per box.
#
Days/Weeks/Months
Row 0, Column 0
Days
Weeks
Months
Days
Weeks
Months
Row 0, Column 1
#
Row 0, Column 0
Days/Weeks/Months
Days
Weeks
Months
Days
Weeks
Months
Row 0, Column 1
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8
What were your normal hours of operation BEFORE the flood?
Please only input a single number per box. Leave blank if you were not open on that day.
Open
Close
Sunday
Row 0, Column 0
Row 0, Column 1
Monday
Row 1, Column 0
Row 1, Column 1
Tuesday
Row 2, Column 0
Row 2, Column 1
Wednesday
Row 3, Column 0
Row 3, Column 1
Thursday
Row 4, Column 0
Row 4, Column 1
Friday
Row 5, Column 0
Row 5, Column 1
Saturday
Row 6, Column 0
Row 6, Column 1
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Open
Row 0, Column 0
Close
Row 0, Column 1
Open
Row 1, Column 0
Close
Row 1, Column 1
Open
Row 2, Column 0
Close
Row 2, Column 1
Open
Row 3, Column 0
Close
Row 3, Column 1
Open
Row 4, Column 0
Close
Row 4, Column 1
Open
Row 5, Column 0
Close
Row 5, Column 1
Open
Row 6, Column 0
Close
Row 6, Column 1
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9
Are your days/hours of operation different since the flood?
YES
NO
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10
If yes, please explain the difference in operating hours.
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11
What was your average sales/revenue before flood?
Complete the time range easiest to compute - an estimate or range is okay.
$
Per Day/Week/Month
Avg. Sales BEFORE Flood
Row 0, Column 0
Per Day
Per Week
Per Month
Per Day
Per Week
Per Month
Row 0, Column 1
Avg. Sales BEFORE Flood
$
Row 0, Column 0
Per Day/Week/Month
Per Day
Per Week
Per Month
Per Day
Per Week
Per Month
Row 0, Column 1
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12
Have your sales/revenue returned to preflood levels?
YES
NO
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13
What was the total amount of sales/revenue you lost while closed?
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14
Total damage or cost to repair/replace/rebuild damage?
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15
Was your business protected by insurance?
YES
NO
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16
If yes, what percentage of the loss or how much (in dollars) did you receive to repair/rebuild your business?
Amount
$
Row 0, Column 0
%
Row 1, Column 0
$
%
Amount
Row 0, Column 0
Amount
Row 1, Column 0
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17
Please provide the following:
Please only input a single number per box - an estimate is okay.
$
Annual Sales/Revenue BEFORE the flood
Row 0, Column 0
Total Damage/Loss
Row 1, Column 0
Annual Sales/Revenue BEFORE the flood
Total Damage/Loss
$
Row 0, Column 0
$
Row 1, Column 0
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18
Please explain the main reasons you did not reopen your business after the flood.
0/500
Huge
Large
Normal
Small
Ok
quote
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19
Name of person completing this survey
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20
If we may contact you for follow-up questions, please provide the best telephone number to reach you.
Please enter a valid phone number.
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