Subject to: OMB Control #0693-0078; Expiration Date: 07/31/2022
(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 |
Federal classification of the business: _____
Woman-owned B. Minority certified by the SBA (8a) C. Veteran-owned D. NONE
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 [wildfire or smoke from wildfire] did this location experience and in what year [associated “name” and/or year] _______________________________________________________________________
[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 lOcation for this business.)
What is your role with this business? 1. Owner 2. Manager 3. Owner and Manager
How many years have you worked as a business owner/manager?
At this location: _____________ (years)
In your total career: _____________ (years)
Did you undertake any advance preparation/activities to prepare for potential hazards? 1. Yes 2. No
If Yes [q 6], 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]
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Primary Damage Description |
DS0 |
DS1 |
DS2 |
DS3 |
Buildings |
Ignition (flaming or smoldering) |
No damage |
Light damage -- such as broken windows, slight damage to roofing and siding, interior partitions blown down, and cracked walls; the damage is not severe enough to preclude use of the installation for the purpose for which it was intended |
Moderate damage -- precludes effective use of the structure, facility, or object for its intended purpose, unless major repairs are made short of complete reconstruction. |
Severe damage -- precludes further use of the structure, facility, or abject for its intended purpose.
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Smoke |
No damage |
Light damage – the damage is not severe enough to preclude use of the installation for the purpose for which it was intended |
Moderate damage -- precludes effective use of the structure, facility, or object for its intended purpose, unless major repairs are made short of complete reconstruction. |
Severe damage -- precludes further use of the structure, facility, or abject for its intended purpose.
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Content/ Inventory |
Ignition (flaming or smoldering) |
No damage |
All reusable/usable, with zero or slight value drop |
Moderate amount reusable, with moderate value drop |
Little to no reusable, with significant value drop |
Smoke |
No damage |
All reusable/usable, with zero or slight value drop |
Moderate amount reusable, with moderate value drop |
Little to no reusable, with significant value drop |
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Machinery/Equipment |
Ignition (flaming or smoldering) |
No damage |
Operational, with zero or slight value drop |
Partially operational, with moderate value drop |
Non-operational, with significant value drop |
Smoke |
No damage |
Operational, with zero or slight value drop |
Partially operational, with moderate value drop |
Non-operational, with significant value drop |
Was the vegetation adjacent to business damaged? |
No damage |
Minor damage—will recover in a 1-2 years |
Major damage—will take 3-10 years to recover |
Catastrophic damage—will take more than 10 years to recover |
Was the vegetation around the community damaged? |
No damage |
Minor damage—will recover in a 1-2 years |
Major damage—will take 3-10 years to recover |
Catastrophic damage—will take more than 10 years to recover |
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, for how long? |
![]() 1. Yes 2. No 3. DK 4. N/A [If yes] Did this business use a backup generator? |
____ Hours or _____ days still using generator
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1. Yes 2. No 3. DK 4. N/A Did your business losewater? |
____ Hours or _____ days still don’t have water
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![]() 1. Yes 2. No 3. DK 4. N/A [If yes] Did this business have a backup water supply? |
____ Hours or _____ days still using backup supply
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1. Yes 2. No 3. DK 4. N/A Did your business losenatural gas? |
____ Hours or _____ days still don’t have natural gas
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1. Yes 2. No 3. DK 4. N/A Did your business losesewer? |
____ Hours or _____ days still don’t have sewer
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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 Did your business loseInternet access? |
____ Hours or _____ days still don’t have internet/IT
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1. Yes 2. No 3. DK 4. N/A Did your business loseIT (e.g., access to Critical computer Programs/data) ? |
____ Hours or _____ days still don’t have IT
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1. Yes 2. No 3. DK 4. N/A Did your businessexperience any accessibility issues such as road closures? |
____ Hours or _____ days still don’t have full accessibility
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Were you under an evacuation alert, evacuated the area, or voluntarily left due to hazard conditions? |
____ Hours or _____ days still have not returned |
How long did it take for your business to resume operations? ____________ (all days) Or N/A: operations did not shut down ______.
Were employees unable to access this work location during or after the event? 1. Yes 2. No
If yes [Q10], please answer the following:
11.1 How long did it take for employees to access this work location? _____ (all days)
11.2 Was there an alternate work location available for employees to work while the primary location was closed? 1. Yes 2. No
11.3 If [11.2=yes] How far away was the alternate work location from the primary location? ____ (mi.) ____ not applicable
11.4 If [11.2=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 this business use any other backup systems besides generators or water supply? 1. Yes 2. No
12.1. [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 other 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 ? _______ (calendar not just work days)
14.1 If yes: Was this a complete or partial stoppage? 1. Complete 2. Partial; Time: ______ (all days, not just work days)
14.2 Did the business experience any other supply chain issues; please explain briefly: ____________________________________________________________________________________
During the event, operations were at:
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2. 80-99% |
3. 50-79% |
4. 30-49% |
5. 1-29% |
6. 0% (operations completely ceased)
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Did you make the decision to close the business prior to the event? 1. Yes 2. No
If yes [Q16], 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?
_________________________________________
If no [Q16], during or after the event, did the business close? 1. Yes 2. No
If yes [Q18], please answer the following:
19.1 Was it a required closure because it could not function given damage?
19.2 Who made the final determination? 1. Owner 2. Manager 3. Local policy/requirement 4. Other ______
19.3 What information was used to make this decision? _________________________________________
Which of the following did you use to get your information? (mark all that apply)
local network tv news
National TV
Weather Channel
Accuweatherer.
Local government
social media
AirNow.gov
Community leaders
radio
internet source
friends/family
social media
National Weather Service
OTHER _____________
20.1 What was the most important information used to close your business?
21. How did the business communicate the status of the business (e.g., open or not) to potential customers and the public? (all that apply) 1. Telephone 2. E-mail 3. Text message 4. Social media 5. Other _____
22. 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
Other ________________________________
Did the experience of this event change your approach to planning for possible future smoke/fire?
23.1
If yes [Q23], how (please explain
briefly)?
_____________________________________________________________________________________
23.2
If no [Q23], why not (please explain
briefly)?
_____________________________________________________________________________________
Did employees have to spend extra hours at work before, during, or after 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 __________
26. Did your business experience any issues with employees’ ability to report to work (once you began operation post-event)?
28.1. Employee(s) could not report to work due to transportation problems/road closures/or they were evacuated? 1. Yes 2. No
28.2. Employee(s) could not report to work due to the need to repair damage to their property? 1. Yes 2. No
Employee(s) could not report to work because their children not yet back to school? 1. Yes 2. No
28.4 Employee(s) could not report to work due to hazard-related physical health issue? 1. Yes 2. No
28.5 Employee(s) could not report to work due to disaster-related mental health issues? 1. Yes 2. No
28.6 Other (please explain):____________________________________________________________
27. Are you aware of any employee long-term health effects arising from the event (e.g., increased issues with asthma)? 1. Yes 2. No
28. In which year was this business established at this location? _______ (Year)
29. What is your primary line of business?
Construction
Manufacturing
Retail trade
Service
Other (please specify): _______________________________________
30. Before the most recent 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 ____________
If the number of employees has changed after the event, was the change related to the event? 1. Yes 2. No
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): __________________________________
33. Compared to before the 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.)
34. Did the business revenue change following the [event]? (Please reference gross revenue.) If yes:
1. Decreased greatly
Decreased
Stayed the same
Increased
Increased greatly
35. Has profitability of the business been impacted by the [event]?
If yes, how has profitability changed since the event?
37.a. Before |
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37.b. Now |
36. Where do you feel your business stands 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
37. Did this business experience a loss of customers during this event or in the remainder of the season?
1. Lost customers (_____% loss) 2. Remained the same 3. Gained customers (___% gain)
38. Did your business have any type of oral or written plan: covering business continuity plan, disaster plan, employee training, (circle all that apply) to guide the actions of you and your employees through the hazard? 1. Yes 2. No 3. other_______________________________
38.1. [If 41=”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
38.2. [If 41=”Yes”] Have you updated your plan with the lessons learned from this event? 1. Yes 2. No 3. D/K
38.3 [If 41=”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
39. Did you have insurance coverage related to this disaster type on the building, contents, or business interruption before the event? 1. Yes 2. No 3. D/K
40. 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 3. D/K |
1. Yes 2. No 3. D/K |
1. Yes 2. No 3. We paid for all |
1. Yes 2. No 3. pending |
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Content (business insurance/most relevant to renters) |
1. Yes 2. No 3. D/K |
1. Yes 2. No 3. D/K |
1. Yes 2. No 3. We paid for all |
1. Yes 2. No 3. pending |
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Business interruption |
1. Yes 2. No 3. D/K |
1. Yes 2. No 3. D/K |
1. Yes 2. No 3. We paid for all |
1. Yes 2. No 3. pending |
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41. 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. Loan from a Bridge Loan* program |
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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** Bridge Loan: typically, loans between $1,000 and $50,000 for up to one year. While the bridge loan is a source of expedient funds, it is not designed to be the primary source of assistance for affected small businesses
42. Was there assistance did you needed but did not have? (monetary or in-kind): ____________________________
43. How long do you estimate this business could function in a deficit (X days, weeks, months)? _______
44. Have you taken any mitigation actions since [event name]? If yes, which [of the following or other]? (select all that apply)
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45. What are your thoughts today about extreme events such as the one discussed in this survey, regarding the economy of your community?
_____________________________________________________________________________________
Have there been changes in the severity of impacts and frequency of extreme events affecting your business?
48.1. Severity (of impacts) |
1. Decreasing greatly 2. Decreasing 3. Unchanged 4. Increasing 5. Increasing greatly |
48.2. Frequency |
1. Decreasing greatly 2. Decreasing 3. Unchanged 4. Increasing 5. Increasing greatly |
46. How many similar events [insert event type] have occurred at this location that have required your business to close temporarily or greatly reduced the number of people coming to your business (e.g., the business was inaccessible, decided to close)?
Wildfire-related: ______________________ (if applicable, list names/dates, direct threat vs. smoke impacts, evacuated or under get ready-to-evacuate orders if direct threat)
47. Are there resources you’ve gotten from your local government, wildfire programs or fire agencies that have been useful? If yes, what?
________________________________________________________________________________________
48. Is there
specific types of support you’d like to see provided by local
government? If yes,
what?
________________________________________________________________________________________
49. What is your age? ________________ (years)
50. 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
5. Bachelors
6. Masters or higher degree
51. Are you Hispanic? Yes/no
52. What is your race? Select one or more.
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53. What is your household income? (per year before taxes)
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e. $80,000-$99,999 |
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f. $100,000-$124,999 |
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g. $125,000-$149,999 |
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h. 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.
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Author | yu Xiao |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |