Agency Status Survey
Please visit: http://feedingtampabay.org/agency-cvprep/ for more information
Name of Agency
*
Agency Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County of Agency
*
Citrus
Hardee
Hernando
Highlands
Hillsborough
Manatee
Pinellas
Pasco
Polk
Sumter
Primary Contact Name
*
First Name
Last Name
Primary Contact Phone Number
*
-
Area Code
Phone Number
Primary Contact Email
*
example@example.com
Secondary Contact Name
*
First Name
Last Name
Secondary Contact Phone Number
*
-
Area Code
Phone Number
Secondary Contact Email
*
example@example.com
What is the current status of your agency?
*
operating as normal
temporarily closed
Does your agency plan to operate/respond in the event of an outbreak?
*
yes
no
unsure
Have you made changes to your distribution times due to Coronavirus?
*
yes, increased hours/days of distribution
yes, decreased hours/days of distribution
no changes
Has your agency experienced a decline in volunteers due to Coronavirus?
*
yes
no
Has your agency experienced an increase or decrease in clients due to Coronavirus?
*
increase
decrease
Is your agency taking additional safety precautions due to Coronavirus?
Using gloves
Pre-packaging
Distributing outisde
Drive-thru distribution
Limiting the number of people in the pantry
Other
Does your agency offer home delivery?
*
yes
no
If your agency does offer home delivery, do you plan to shift to a "no contact" doorstep delivery?
*
yes
no
N/A
Does your agency participate in the AERP program and pick up directly from retail partners?
*
yes
no
Does your agency currently operate a Mobile Pantry or a Mobile Pantry Drop with Feeding Tampa Bay?
*
yes
no
If your agency answered yes to operating a Mobile Pantry or Mobile Pantry Drop with Feeding Tampa Bay, do you plan to continue to operate the Mobile Pantry in the event of an outbreak?
*
yes
no
N/A
Please fill out the table below on the days and times your agency currently distributes food to the community.
*
Time Start
Time End
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What is the percentage of seniors your agency currently serves?
*
We do not have a senior population at our agency.
1%-25%
26%-50%
51%-75%
76%-99%
We only serve the senior population.
Please list all Feeding Tampa Bay programs your agency participates in:
Shopping at FTB Warehouse
Agency Express
Bulk Pick Up
Retail Route Drop
AERP (Store Pick-Up Program)
Just in Time Produce Delivery
Hub Drop
USDA TEFAP
USDA CSFP
Other
Which of the following applies to your agency -
We have the food and supplies we need to serve our community.
We have seen our overall food and supply levels go down, but we can still meet most needs.
The decrease of supplies and food has significantly impacted our ability to operate.
Please outline any needs you have of Feeding Tampa Bay to meet the needs of your clients.
What additional steps have you taken at your agency to protect against Coronavirus?
Additional Comments / Questions
Submit
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