Question Bank

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Overview

Readme
Summary

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Sheet 1: Readme

Monday, August 09, 2021
Question Bank of Cognitively Tested Questions for use with the Generic Clearance for Emergency Economic Information Collections (EEIC)
Version 1.0
This document contains an inventory or bank of survey questions to be used for monitoring the impact on the economy in the event of an unexpected emergency -- e.g., natural disasters, pandemic -- that threatens the livelihood and well-being of the public. This draft contains a cadre of potential survey questions proposed by Cennsus Bureau and its stakeholders, and augmented with questions proposed by our collaborator, RTI International. These questions are, or will be, undergoing cognitive testing, as required by OMB and Census Bureau standards, prior to fielding in a production survey. This current version, 1.0, contains a) questions that have been cognitively tested and performed adequately during one round of testing: b) cognitively tested questions recommemded to undergo a 2nd round of testing; c) questions undergoing a first round of cogntive testing at the time of this writing; and d) questions/topics yet to undergo cogntive testing. Thus, this Question Bank should be considered a LIVING DOCUMENT, and it will be updated as testing is completed and/or when new topics/questions are proposed.
Legend
Tab name		Content
Readme		Legend/guide
Summary		Round 1 testing results
Column name in Summary tab		Content
RTI_RID (hidden)		Internal identifier for questions
Wave	NOTE: The Wave number and the Question number within the Wave are provided to inform the user of the context within which the Question was tested.	The identifier of the testing wave of the question
Wave Q #		Unique identifier for questions in Round 1 testing
Decision after Round 1 cognitive testing		Decision after Round 1 regarding the next steps COLOR CODED
Topics		The topics of questions
Original or Revised Question Text (Quex Bank version or Round 2 Testing)		The current iteration of the question stem
If grid, subitems	NOTE: These columns are completed for "tested and acceptable" questions only in Version 1.0 (8-9-2021).	The statement/items organized across the rows in the grid format
Response options		The response options of the question. For the grid format, these refer to the headers of the columns
Notes		Content
<fill variable>		Varying elements of the questions
[bracket]		Programming elements such as skip logic for questions or response options
* next to the question number		These questions are single item versions of grid questions. Only 2 single items were selected for testing and these questions have been included in this document. The full question bank should include all single item questions from the final tested grid.
** next to the question number		These questions have two possible question formats to consider for testing in Round 2. Only one version is included in this document as we work through which version will be included in final testing in Round 2.
Color-coding to indicate the current status of the question
Tested – acceptable
Tested – revised and awaiting 2nd round of testing
To be tested
Being tested
Previously tested by Census Bureau – acceptable

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Sheet 2: Summary

Wave	Wave Q #	Decision after Round 1	Topics	Original or Revised Question Text (Quex Bank version or Round 2 Testing)	If grid, subitems	Response options
1	Q01	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Changes in number of employees	From <date 1> to <date 2>, how did this <business/agency/etc.> change the following aspects of staffing as the result of <event>? <worker specification as needed>
1	Q01_1*	Tested – acceptable	Employees and payroll_Changes in number of employees	From <date 1> to <date 2>, how did this <business/agency/etc.> change the total number of shifts <for hourly employees> as the result of <event>? <worker specification as needed>		Increased Did not change Decreased Not applicable
1	Q01_2*	Tested – acceptable	Employees and payroll_Changes in number of employees	From <date 1> to <date 2>, how did this <business/agency/etc.> change bonuses as a result of <event? <worker specification as needed>		Increased Did not change Decreased Not applicable
1	Q02	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Changes in types of employees	How many of this <business/agency/etc.>'s employees were classified as the following types of workers on <date 1> and <date 2>? Enter 0 if the <business/agency/etc.> has no workers of that type.
1	Q03	Tested – acceptable	Employees and payroll_Changes in number of employees	Between <date 1> and <date 2>, what percentage of the following types of workers did this <business/agency/etc.> lay off temporarily and permanently as a result of <event>? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months. Permanently laid off workers have no expectation of being rehired within 6 months. Estimates are acceptable. Enter 0 if no layoffs.	Full-time <paid> employees (workers who received a W-2) Part-time <paid> employees (workers who received a W-2) Workers who do not fall into any of the categories above	Columns: Temporarily laid off, Permanently laid off, Not applicable Responses: [text box]
1	Q03_1*	Tested – acceptable	Employees and payroll_Changes in number of employees	Between <date 1> and <date 2>, what percentage of part-time <paid> employees (workers who received a W-2) did this <business/agency/etc.> lay off temporarily and permanently as a result of <event>? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months. Permanently laid off workers have no expectation of being rehired within 6 months. Estimates are acceptable. Enter 0 if no layoffs.		Temporarily laid off [text box] % Permanently laid off [text box] % Not applicable
1	Q03_2*	Tested – acceptable	Employees and payroll_Changes in number of employees	Between <date 1> and <date 2>, what percentage of temporary staff, leased employees, contractors, subcontractors, independent contractors, and outside consultants did this <business/agency/etc.> lay off temporarily and permanently as a result of <event>? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months. Permanently laid off workers have no expectation of being rehired within 6 months. Estimates are acceptable. Enter 0 if no layoffs.		Temporarily laid off [text box] % Permanently laid off [text box] % Not applicable
1	Q04	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Changes in number of employees	From <date 1> to <date 2>, how did the following factors related to <event> change this <business/agency/etc.>'s total number of <paid> employees?
1	Q05	Tested – acceptable	Employees and payroll_Rehiring of furloughed or laid off employees	From <date 1> to <date 2>, what percentage of temporarily laid off <paid> employees did this <business/agency/etc.> recall or rehire? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months. Enter 0 if no temporarily laid off workers have been recalled or rehired		[text box] % Not applicable
1	Q06	Tested – acceptable	Employees and payroll_Rehiring of furloughed or laid off employees	Did this <business/agency/etc.> receive <an event>-related loan or grant tied to recalling or rehiring <paid> employees or maintaining employees on the payroll <such as <examples TBD>>?		Yes No
1	Q07	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Rehiring of furloughed or laid off employees	Compared to what was normal before <event>, how many hours did temporarily laid off employees have in the month after they returned to work? <Instructions for defining and producing HR records as needed (e.g., include/do not include seasonal employees).> Select all that apply. Temporarily laid off employees are those who have been given a date to return to work or who are expected to return to work within 6 months.
1	Q08	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Rehiring of furloughed or laid off employees	Compared to what was normal before <event>, what changes did temporarily laid off employees have in their salary or wages when they returned to work? <Instructions for defining and producing HR records as needed (e.g., include/do not include seasonal employees).> Select all that apply. Temporarily laid off employees are those who have been given a date to return to work or who are expected to return to work within 6 months.
2	Q09	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Recent changes in benefits paid or provided to employees	From <date 1> to <date 2>, did this <business/agency/etc.> offer the following benefits to <all/any> <paid> employees? <Include benefits paid for by employers and employees.>
2	Q10	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Recent changes in benefits paid or provided to employees	From <date 1> to <date 2>, what changes did this <business/agency/etc.> make to the following benefits for <any/all> <paid> employees as a result of <event>? <Include benefits paid for by employers and employees.> Select all that apply.
2	Q10_1*	Tested – acceptable	Employees and payroll_Recent changes in benefits paid or provided to employees	From <date 1> to <date 2>, what changes did this <business/agency/etc.> make to critical illness insurance for <any/all> <paid> employees as a result of <event>? Critical illness insurance is a special form of insurance that pays the policyholder a lump-sum, tax-free payment if they suffer from serious illness, including but not limited to cancer, heart attack, kidney failure and stroke. <Include benefits paid for by employers and employees.> Select all that apply.		Introduced benefit Increased benefit Did not change benefit Reduced benefit Eliminated benefit Not applicable
2	Q10_2*	Tested – acceptable	Employees and payroll_Recent changes in benefits paid or provided to employees	From <date 1> to <date 2>, what changes did this <business/agency/etc.> make to paid time off such as vacation or sick leave for <any/all> <paid> employees as a result of <event>? <Include benefits paid for by employers and employees.> Select all that apply.		Introduced benefit Increased benefit Did not change benefit Reduced benefit Eliminated benefit Not applicable
2	Q11	Tested – acceptable	Employees and payroll_Benefits paid or provided to laid off employees	From <date 1> to <date 2>, did this <business/agency/etc.> continue to pay all or a portion of health insurance premiums for any <paid> employees who were temporarily laid off as a result of <event>? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months.		Yes No Not applicable
2	Q12	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Benefits paid or provided to laid off employees	From <date 1> to <date 2>, what changes did this <business/agency/etc.> make to the following benefits for <any/all> <paid> employees who were temporarily laid off as a result of <event>? <Include benefits paid for by employers and employees.> Select all that apply. Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months.
2	Q12_1*	Tested – acceptable	Employees and payroll_Benefits paid or provided to laid off employees	From <date 1> to <date 2>, what changes did this <business/agency/etc.> make to health insurance for <any/all> <paid> employees who were temporarily laid off as a result of <event>? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months. <Include benefits paid for by employers and employees.> Select all that apply.		Introduced benefit Increased benefit Did not change benefit Reduced benefit Eliminated benefit Not applicable
2	Q12_2*	Tested – acceptable	Employees and payroll_Benefits paid or provided to laid off employees	From <date 1> to <date 2>, what changes did this <business/agency/etc.> make to Employee Assistance Program (EAP) services for <any/all> <paid> employees who were temporarily laid off as a result of <event>? Temporarily laid off workers are those who have been given a date to return to work or who are expected to return to work within 6 months. <Include benefits paid for by employers and employees.> Select all that apply.		Introduced benefit Increased benefit Did not change benefit Reduced benefit Eliminated benefit Not applicable
2	Q13	Tested – acceptable	Employees and payroll_Recent changes in benefits paid or provided to employees	From <date 1> to <date 2>, how many paid sick days did this <business/agency/etc.> voluntarily add to its sick leave policy <for <all/any> <paid> employees> as a result of <event>? Do not include state or federally mandated paid leave.		0 days 1-5 days 6-10 days More than 10 days Not applicable
2	Q14	Tested – revised and awaiting 2nd round of testing	Employees and payroll_Recent changes in benefits paid or provided to employees	[GATE] Between <date1> to <date2>, did this <business/agency/etc.>'s sick leave policy include unpaid sick days? [IF GATE = YES] From <date1> to <date2>, how many unpaid sick days did this <business/agency/etc.> voluntarily add to its sick leave policy as a result of <event>? Do not include state or federally mandated unpaid leave.
2	Q15	Tested – acceptable	Employees and payroll_Recent changes in benefits paid or provided to employees	[Ask if Q13>1] Are any of the changes this <business/agency/etc.> made between <date 1> and <date 2> to its sick leave policy as a result of <event> temporary? Do not include state or federally mandated changes to paid or unpaid leave.		Yes No Not applicable
3	Q16	Tested – acceptable	Employees and payroll_General	From <date 1> to <date 2>, did this <business/agency/etc.> take the following actions related to staffing as a result of <event>?	Temporary layoffs (workers are given a date to return to work or are expected to return to work within 6 months) Permanent layoffs (workers have no expectation of being rehired within 6 months) Hiring freezes Hiring additional <paid> employees	Yes No Not applicable
3	Q17	Tested – acceptable	Employees and payroll_General	How likely do you think this <business/agency/etc.> is to take the following actions related to staffing in <future time period> as a result of <event>?	Temporary layoffs (workers are given a date to return to work or are expected to return to work within 6 months) Permanent layoffs (workers have no expectation of being rehired within 6 months) Hiring freezes Hiring additional <paid> employees	Extremely likely Somewhat likely Not at all likely
3	Q18	Tested – revised and awaiting 2nd round of testing	Employees and payroll_General	From <date 1> to <date 2>, did this <business/agency/etc.> take the following actions related to compensation as a result of <event>?
3	Q19	Tested – acceptable	Employees and payroll_General	How likely do you think this <business/agency/etc.> is to take the following actions related to compensation in <future time period> as a result of <event>?	Hourly wage or salary freezes Reduction in hourly wages or salaries Increase in hourly wages or salaries Bonus freezes or delay Emergency bonus pay or hazard pay Retirement saving contribution freezes Reduction in healthcare benefit coverage	Extremely likely Somewhat likely Not at all likely
3	Q20	Tested – acceptable	Employees and payroll_General	From <date 1> to <date 2>, did this <business/agency/etc.> take the following actions related to shifts or hours as a result of <event>?	Reduction in overtime Increase in overtime Reduction in shifts or hours Increase in shifts or hours	Yes No Not applicable
3	Q21	Tested – acceptable	Employees and payroll_General	How likely do you think this <business/agency/etc.> is to take the following actions related to shifts or hours in <future time period> as a result of <event>?	Reduction in overtime Increase in overtime Reduction in shifts or hours Increase in shifts or hours	Extremely likely Somewhat likely Not at all likely
3	Q22	Tested – acceptable	Employees and payroll_General	From <date 1> to <date 2>, did this <business/agency/etc.> have less difficulty, no change, or more difficulty in recruiting workers in the following occupations compared to what was normal before <event>?	Management Business and Financial Operations Building and Grounds Cleaning and Maintenance Sales and Related Office and Administrative Support Production Other (please specify):	Less difficulty No change More difficulty Not applicable
3	Q23	Tested – acceptable	Employees and payroll_General	From <date 1> to <date 2>, did this <business/agency/etc.> have less difficulty, no change, or more difficulty in retaining workers in the following occupations compared to what was normal before <event>?	Management Business and Financial Operations Building and Grounds Cleaning and Maintenance Sales and Related Office and Administrative Support Production Other (please specify):	Less difficulty No change More difficulty Not applicable
3	Q24	Tested – acceptable	Employees and payroll_Voluntary turnover	From <date 1> to <date 2>, did this <business/agency/etc.> have higher than usual, no change in, or lower than usual voluntary <paid> employee turnover as a result of <event>? Voluntary turnover occurs when an employee chooses to leave a position that then needs to be refilled.		Higher than usual No change Lower than usual <Don't know>
3	Q25	Tested – acceptable	Employees and payroll_Changes in number of employees	From <date 1> to <date 2>, how did the number of <employee type> at this <business/agency/etc.> change as a result of <event>?		Increased Did not change Decreased
3	Q26	Tested – acceptable	Employees and payroll_Changes in payroll	From <date 1> to <date 2>, how did this <business/agency/etc.>'s total payroll for <employee type> change as a result of <event>?		Increased Did not change Decreased
3	Q27	Tested – acceptable	Employees and payroll_Changes in payroll	What was this <business/agency/etc.>’s total payroll for <employee type> in <quarter>?		[text box]
3	Q28	Tested – acceptable	Employees and payroll_Changes in payroll	How did this <business/agency/etc.>'s total payroll for <paid> employees for the <quarter> change as the result of <event>?		Increased Did not change Decreased
4	Q29	Tested – revised and awaiting 2nd round of testing	Provision of services_Changes in number of clients served or service offering(s)	From <date1> to <date2>, how much did demand for this <business/agency/etc.>’s goods or services change compared to what was normal before <event>?
4	Q30	Tested – acceptable	Provision of services_Changes in number of clients served or service offering(s)	From <date 1> to <date 2>, how did this <business/agency/etc.>’s client/customer base change as a result of <event>?		Increased Did not change Decreased
4	Q31	Tested – acceptable	Revenue, expenses, etc._Changes in sales or revenue	How did the prices of goods or services sold by this <business/agency/etc.> change from <date 1> to <date 2> compared to what was normal before <event>?		Prices increased Prices did not change Prices decreased Not applicable
4	Q32	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	From <date 1> to <date 2>, how did this <business/agency/etc.>’s number of order cancellations change compared to what was normal before <event>? <a brief definition of order cancellation to be provided for conprehension testing in Round 2>
4	Q33**	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	From <date 1> to <date 2>, how did this <business/agency/etc.>’s <net/gross> profits change compared to what was normal before <event>?
4	Q34**	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	From <date 1> to <date 2>, how did this <business/agency/etc.>’s <revenues/sales/receipts> change compared to what was normal before <event>?
4	Q35**	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	How much did this <business/agency/etc.>’s <revenues/sales/receipts> change in the <quarter> of <year> (month 1 – month 2) compared to what was normal before the <event>?
4	Q36	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	From <date 1> to <date 2>, did the following factors limit this <business/agency/etc.>’s <revenues/sales/receipts>?
4	Q37	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	From <date 1> to <date 2>, how did this the <business/agency/etc.>’s <revenues/sales/receipts> for goods or services sold online change compared to what was normal before <event>?
4	Q38	Tested – acceptable	Revenue, expenses, etc._Changes in sales or revenue	Do you anticipate that the changes in this <business/agency/etc.>’s <revenues/sales/receipts> for goods or services sold online in <time period (date 1 ─ date 2)> are temporary?		Yes No <Don't know>
4	Q39	Tested – acceptable	Revenue, expenses, etc._General	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> require any additional financial assistance or loans to continue operation?		Yes No <[If yes selected] Please describe:____>
4	Q40	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._General	From <date 1> to >date 2>, as a result of <event>, did this <business/agency/etc.> apply for any additional financial assistance or loans to continue operation?
4	Q41	Tested – acceptable	Revenue, expenses, etc._General	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> receive any additional financial assistance or loans to continue operation?		Yes No <[If yes selected] Please describe:____>
4	Q42	Tested – acceptable	Revenue, expenses, etc._Application for and use of government loans/assistance	As a result of <event>, did this <business/agency/etc.> apply for any government loans or assistance from <date 1> to <date 2>?		Yes No
4	Q43	Tested – acceptable	Revenue, expenses, etc._Application for and use of government loans/assistance	As a result of <event>, did this <business/agency/etc.> receive any government loans or assistance from <date 1> to <date 2>?		Yes No
4	Q44	Tested – acceptable	Revenue, expenses, etc._Application for and use of government loans/assistance	What was the total dollar amount of government loans and assistance this <business/agency/etc.> received from <date 1> to <date 2>?		$[text box]
5	Q45	Tested – acceptable	Provision of services_New services	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> provide new goods and/or services?		Yes No <[If yes selected] Please describe:____>
5	Q46	Tested – acceptable	Provision of services_New services	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> do the following regarding the goods and/or services it offers?	Sell a new good or offer a new service that this <business/agency/etc.> has never offered before Improve a good or service’s performance by making changes in materials, equipment, software, or other components Develop a new use for a good or service Add a new feature to a good or service Make it easier for customers to use a good or service	Yes No Not applicable
5	Q47	Tested – acceptable	Provision of services_Services eliminated	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> eliminate any of the goods and/or services it usually offers?		Yes No Not applicable
5	Q48	Tested – acceptable	Provision of services_Services eliminated	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> suspend any of the goods and/or services it usually offers?		Yes No Not applicable
5	Q49	Tested – acceptable	Revenue, expenses, etc._Application for and use of government loans/assistance	Since <date 1>, from which of the following sources has this <business/agency/etc.> requested financial assistance as a result of <event>? Select all that apply.		Banks Owners Family or friends <specific Federal programs of interest> State or local government programs <Event-specific finanical assistance> Other (please specify) Not applicable
5	Q50	Tested – acceptable	Revenue, expenses, etc._Application for and use of government loans/assistance	Since <date 1>, from which of the following sources has this <business/agency/etc.> received financial assistance as a result of <event>? Select all that apply.		Banks Owners Family or friends <specific Federal programs of interest> State or local government programs <Event-specific finanical assistance> Other (please specify) Not applicable
5	Q51	Tested – acceptable	Revenue, expenses, etc._Changes in business forecast	As a result of <event>, how did this <business/agency/etc.>’s original revenue forecast for <time period 1> change as compared <time period 2>?		Increased Did not change Decreased Not applicable
5	Q52	Tested – acceptable	Revenue, expenses, etc._Changes in capital expenditure plans	As a result of <event>, how did this <business/agency/etc.> change its budgeted capital expenditures for <time period>? Select all that apply.		Cancelled budgeted capital expenditure(s) Decreased budgeted capital expenditure(s) Postponed budgeted capital expenditure(s) Increased budgeted capital expenditure(s) Introduced new unbudgeted capital expenditure(s) No changes Not applicable
5	Q53	Tested – acceptable	Revenue, expenses, etc._Changes in operating budget	From <date 1> to <date 2>, how did this <business/agency/etc.>’s operating budget change compared to the normal budget in <previous time period> before <event>?		Increased Did not change Decreased Not applicable
5	Q54	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in sales or revenue	From <date 1> to <date 2>, as the result of <event>, how did this <business/agency/etc.>’s operating <revenues/sales/receipts> change compared to the normal budget in <previous time period> before <event>? Do not include any financial assistance or loans.
5	Q55	Tested – acceptable	Revenue, expenses, etc._Changes in expenses	From <date 1> to <date 2>, how did this <business/agency/etc.>’s expenses change compared to what was normal before <event>?		Expenses increased Expenses did not change Expenses decreased
5	Q56	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Changes in expenses	From <date 1> to <date 2>, did this <business/agency/etc.> take the following measures as a result of <event>?
5	Q57	Tested – acceptable	Revenue, expenses, etc._Access to private sources of capital (e.g., applying for a loan, receiving a loan)	From <date 1> to <date 2>, did this <business/agency/etc.> already have a business term loan or a line of credit?		Yes No
5	Q58	Tested – acceptable	Revenue, expenses, etc._Access to private sources of capital (e.g., applying for a loan, receiving a loan)	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> ask its lender about deferring payments for a business term loan or a line of credit?		Yes No
5	Q59	Tested – acceptable	Revenue, expenses, etc._Access to private sources of capital (e.g., applying for a loan, receiving a loan)	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.>’s lender allow for payment deferral for this <business/agency/etc.>’s business term loan or line of credit?		Yes No
5	Q60	Tested – acceptable	Revenue, expenses, etc._Application for and use of government loans/assistance	From <date 1> to <date 2>, did this <business/agency/etc.> receive any financial assistance related to <event>?		Yes No
5	Q61	Tested – revised and awaiting 2nd round of testing	Revenue, expenses, etc._Application for and use of government loans/assistance	Did this <business/agency/etc.> spend this financial assistance on the following?
5	Q62	Tested – acceptable	Revenue, expenses, etc._Changes to operating budget	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> ask its lender or property owner about deferring rent or mortgage payments?		Yes No Not applicable
5	Q63	Tested – acceptable	Revenue, expenses, etc._Changes to operating budget	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.>’s lender or property owner allow for rent or mortgage payment deferral?		Yes No
6	Q64	Tested – revised and awaiting 2nd round of testing	Changes in manufacturing production_General	From <date 1> to <date 2>, as a result of <event>, how did this <business/agency/etc.>’s production of goods change compared to what was normal before <event>?
6	Q65	Tested – acceptable	Changes in manufacturing production_General	From <date 1> to <date 2>, why did this this <business/agency/etc.>’s production decrease compared to what was normal before <event>? Select all that apply.		Shortage of materials Lack of orders Shortage of labor force/skills Shortage of fuel or electric energy Equipment limitations Storage limitations Logistics/transportation constraints Sufficient inventory of finished goods on hand Strike or work stoppage Environmental restrictions Other (please specify):
6	Q66	Tested – acceptable	Changes in manufacturing production_General	From <date 1> to <date 2>, how many days of production were lost as a result of <event>? Please enter “0” if none.		[text box]
6	Q67	Tested – acceptable	Changes in manufacturing production_Elimination of certain goods being produced	From <date 1> to <date 2>, did this <business/agency/etc.> stop production of any good that it usually produces as a result of <event>?		Yes No
6	Q68	Tested – acceptable	Changes in manufacturing production_Elimination of certain goods being produced	Was this stop in production permanent or temporary?		Permanent for all goods Temporary for all goods Permanent for some goods, temporary for other goods Don't know
6	Q69	Tested – revised and awaiting 2nd round of testing	Changes in manufacturing production_Elimination of certain goods being produced	From <date 1> to <date 2>, did <event> cause this <business/agency/etc.> to stop production of any goods that it usually produces due to the following?
6	Q70	Tested – acceptable	Changes in manufacturing production_Shift in the production line and return to original production	How long do you think it will take for this <business/agency/etc.>’s production of goods to return to what was normal before <event>?		Less than 1 week 1 week to less than 1 month 1 month to less than 3 months 3 months to less than 6 months Longer than 6 months Not applicable
6	Q71	Tested – acceptable	Changes in manufacturing production_Production of new goods	From <date 1> to <date 2>, as a result of <event>, did this this <business/agency/etc.> produce new goods and/or provide new services?		Yes No <[If yes selected] Please describe:____>
6	Q72	Tested – revised and awaiting 2nd round of testing	Changes in supply chain_Problems with current supply chain	From <date 1> to <date 2>, did this <business/agency/etc.> experince disruptions in receiving materials used in production as a result of <event>?
6	Q73	Tested – acceptable	Changes in manufacturing production_Changes in production costs	From <date 1> to <date 2>, how did this <business/agency/etc.>’s prices from suppliers change compared to what was normal before <event>?		Increased Did not change Decreased
6	Q74	Tested – revised and awaiting 2nd round of testing	Changes in supply chain_New supply chain options	From <date 1> to <date 2>, did this this <business/agency/etc.> identify new suppliers as a result of <event>?
7	Q75	Tested – acceptable	Changes in manufacturing production_General	From <date 1> to <date 2>, how much did <event> <positively/negatively> impact this <business/agency/etc.>’s manufacturing production?		A great deal A lot A moderate amount A little Not at all <[If any response option other than"Not at all" selected] Please describe:____>
7	Q76	Tested – acceptable	Changes in manufacturing production_Halt in production	From <date 1> to <date 2>, did this <business/agency/etc.> cease production for at least one day as a result of <event>?		Yes No
7	Q77	Tested – acceptable	Changes in manufacturing production_Shift in the production line and return to original production	From <date 1> to <date 2>, how did this <business/agency/etc.> change its production of goods compared to what was normal before <event>? Select all that apply.		Increased production of goods usually produced No change in production of goods usually produced Decreased production of goods usually produced Stopped production of goods usually produced Started production of goods not usually produced Not applicable
7	Q78	Tested – acceptable	Changes in manufacturing production_Shift in the production line and return to original production	Are these changes to production permanent or temporary?		Permanent for all goods Temporary for all goods Permanent for some goods, temporary for other goods Don't know
7	Q79	Tested – acceptable	Changes in manufacturing production_General	Over the next <time period (date 1 to date 2)>, how do you expect this <business/agency/etc.>’s overall production levels to change compared to what was normal before <event>?		Increase by <%> or more Increase by up to <%> Stay about the same Decrease by up to <%> Decrease by <%> or more
7	Q80	Tested – acceptable	Changes in manufacturing production_Backlogs / unfilled orders	As of <date 2>, how were this <business/agency/etc.>’s unfilled orders (order backlog) affected by <event>, compared to what was normal before <event>?		Increased Did not change Decreased Not applicable
7	Q81	Tested – revised and awaiting 2nd round of testing	Changes in supply chain_General	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> experience a change in lead time required for delivery of any materials used in production? [If Yes] From <date 1> to <date 2>, how did the lead time required for delivery of any materials used in production change compared to what was normal before <event>?
7	Q82	Tested – revised and awaiting 2nd round of testing	Changes in supply chain_General	From <date 1> to <date 2>, how did this <business/agency/etc.> change its level of inventories used to support production compared to what was normal before <event>? Please only consider changes to inventories related to <event>.
7	Q83	Tested – acceptable	Changes in supply chain_Problems with current supply chain	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> experience disruptions in transporting or shipping final products to customers?		Yes No
7	Q84	Tested – acceptable	Changes in supply chain_New supply chain options	From <date1> to <date2>, will this <business/agency/etc.> need to identify new supply chain options as a result of <event>?		Yes No Not applicable
7	Q85	Tested – acceptable	Changes in manufacturing production_Shift in the production line and return to original production	From <date 1> to <date 2>, how did the President’s decision to invoke the Defense Production Act change this <business/agency/etc.>’s production of goods compared to what was normal before <event>? Select all that apply.		Increased production of goods usually produced No change in production of goods usually produced Decreased production of goods usually produced Stopped production of goods usually produced Started production of goods not usually produced Not applicable
7	Q86	Tested – acceptable	Changes in manufacturing production_Shift in the production line and return to original production	Are these changes to production permanent or temporary?		Permanent for all goods Temporary for all goods Permanent for some goods, temporary for other goods Don't know
8	Q87	Tested – revised and awaiting 2nd round of testing	Misc_Inventory losses	From <date1> to <date 2>, as the result of <event>, did the following cause damage to this <business/agency/etc.>’s inventory?
8	Q88	Tested – revised and awaiting 2nd round of testing	Misc_Inventory losses	From <date 1> to <date 2>, as a result of <event>, did this <business/agency/etc.> write off any inventories (e.g., finished goods, raw materials) as damaged, lost, or decreased in value?
8	Q89	Tested – acceptable	Misc_Inventory losses	[Gate for Q90] From <date 1> to <date 2>, did this <business/agency/etc.> experience any inventory losses as a result of <event>?		Yes No
8	Q90	Tested – revised and awaiting 2nd round of testing	Misc_Inventory losses	[If Q89 = yes] What was the total dollar amount of the losses for all inventory that this <business/agency/etc.> experienced? Please include amount before compensation. Estimates are acceptable.
8	Q91	Tested – revised and awaiting 2nd round of testing	Misc_Shipment delays	From <date 1> to <date 2>, did this <business/agency/etc.> experience delays in supplier shipments due to <event>? [If yes] From <date 1> to <date 2>, did delays in supplier shipments due to <event> impact this <business/agency/etc.>’s first quarter <revenues/sales/shipments>?
8	Q92	Tested – revised and awaiting 2nd round of testing	Misc_Shipment delays	From <date 1> to <date 2>, did this <business/agency/etc.> sell any goods or services online? [If Yes] From <date 1> to <date 2>, how much did <event> delay the transportation of goods from this <business/agency/etc.>’s online sales to customers compared to what was normal before <event>?
8	Q93	Tested – acceptable	Misc_Shipment delays	From <date 1> to <date 2>, how did this <business/agency/etc.> change the timing of its shipments to customers as a result of <event>?		Sped up the timing of shipments Did not change the timing of shipments Slowed the timing of shipments Not applicable <[If "Sped up" or "Slowed" is selected] Please describe:____>
8	Q94	Tested – revised and awaiting 2nd round of testing	Misc_Shipment delays	From <date 1> to <date 2>, did this <business/agency/etc.> reroute its shipments to customers in any way as a result of <event>?
8	Q95	Being tested	Misc_Product donations	From <date 1> to <date 2>, did this <business/agency/etc.> donate any products as a result of <event>?
8	Q96	Being tested	Misc_Product donations	What was the value of donated products? Estimates are acceptable.
9	Q97	Being tested	Changes in operations_General	From <date 1> to <date 2>, did your <business/agency/etc.> make any of the following arrangements with suppliers as a result of <event>?
9	Q98	Being tested	Changes in operations_General	From <date 1> to <date 2>, did your <business/agency/etc.> move up the collection of money owed from customers/clients as a result of <event>?
9	Q99	Being tested	Changes in operations_Changes in hours worked	From <date 1> to <date 2>, did this <business/agency/etc.> change its hours of operation as a result of <event>?
9	Q100	Being tested	Closures and work location_Temporary vs. permanent closures	From <date 1> to <date 2>, did this <business/agency/etc.> close temporarily?
9	Q101	Being tested	Changes in operations_Changes in hours worked / Closures and work location_Temporary vs. permanent closures	From <date 1> to <date 2>, did the following factors <related to <event>> influence this <business/agency/etc.>’s decision to <change its hours of operation or close temporarily>?
9	Q102	Being tested	Closures and work location_Building closures / changes in amount of commercial space leased	In the next <time period (date 1 ─ date 2)>, do you anticipate that this <business/agency/etc.> will temporarily or permanently close any locations?
9	Q103	Being tested	Changes in operations_Changes in hours worked	From <date 1> to <date 2>, how did the total number of hours worked by the following types of workers change compared to what was normal before <event>
9	Q104	Being tested	Changes in operations_Operating at a decreased/increased capacity	From <date 1> to <date 2>, how many days was this <business/agency/etc.> operating at a decreased capacity as result of <event>?
9	Q105	Being tested	Changes in operations_General	From <date 1> to <date 2>, did any of this <business/agency/etc.>’s locations adopt pickup/carry-out/delivery as their only means of providing goods and services to their customers?
9	Q106	Being tested	Changes in operations_Changes in level of operations	From <date 1> to <date 2>, was this <business/agency/etc.> designated as essential or non-essential as a result of <event>?
9	Q107	Being tested	Changes in operations_Changes in physical/site operations	From <date 1> to <date 2>, did this <business/agency/etc.> make changes to its business processes to promote social distancing as a result of <event>?
10	Q108	Being tested	Changes in operations_Changes in level of operations	From <date 1> to <date 2>, how did this <business/agency/etc.>’s level of on-site operations change compared to what was normal before <event>?
10	Q109	Being tested	Closures and work location_Temporary vs. permanent closures	From <date 1> to <date 2>, did this <business/agency/etc.> temporarily close any of its locations for at least one day as a result of <event>?
10	Q110	Being tested	Closures and work location_Temporary vs. permanent closures	From <date 1> to <date 2>, how many locations did this <business/agency/etc.> temporarily close for at least one day as a result of <event>?
10	Q111	Being tested	Closures and work location_Temporary vs. permanent closures	From <date 1> to <date 2>, did this <business/agency/etc.> permanently close any of its locations as a result of <event>?
10	Q112	Being tested	Closures and work location_Temporary vs. permanent closures	From <date 1> to <date 2>, how many locations did this <business/agency/etc.> permanently close as a result of <event>?
10	Q113	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, what percent of all <paid> employees at this <business/agency/etc.> worked from home at the following frequencies? Enter 0 if none. Estimates are acceptable.
10	Q114	Being tested	Changes in operations_Changes in level of operations	In your opinion, how much time do you anticipate will pass before this <business/agency/etc.>’s total number of <paid> employees returns to what was normal before <event>?
10	Q115	Being tested	Closures and work location_Building closures / changes in amount of commercial space leased	On <date 1>, did this <business/agency/etc.> lease any real estate properties?
10	Q116	Being tested	Closures and work location_Building closures / changes in amount of commercial space leased	On <date 1>, what percentage of this <business/agency/etc.>’s leased real estate properties were unoccupied?
10	Q117	Being tested	Closures and work location_Building closures / changes in amount of commercial space leased	From <date 1> to <date 2>, did this <business/agency/etc.> lease any assets?
10	Q118	Being tested	Closures and work location_Building closures / changes in amount of commercial space leased	From <date 1> to <date 2>, did this <business/agency/etc.> make the following changes to its approach to leasing assets as a result of <event>?
10	Q119	Being tested	Closures and work location_Building closures / changes in amount of commercial space leased	From < future date 1> to < future date 2>, will this <business/agency/etc.> make the following changes to its approach to leasing assets as a result of <event>?
11	Q120	Being tested	Changes in operations_Changes in level of operations	Which of the following best describes this <business/agency/etc.>’s operations from <date 1> to <date 2>? Select all that apply.
11	Q121	Being tested	Changes in operations_Permanent changes to business practices	Did <event> result in any permanent changes to business practices?
11	Q122	Being tested	Changes in operations_Changes in level of operations	From <date 1> to <date 2>, what was the total amount of time this <business/agency/etc.> was closed to the public <as a result of event>? If this <business/agency/etc.> is still closed to the public, please report the time it has been closed so far.
11	Q123	Being tested	Changes in operations_Changes in hours worked	From <date 1> to <date 2>, how did the <average/total> number of <annual/weekly/monthly/etc.> hours worked <by <employee type>> <at this <business/agency/etc.>> change compared to what was normal before <event>?
11	Q124	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, what percentage of this <business/agency/etc.>’s workforce changed in the following ways? Enter 0 if none. Estimates are acceptable.
11	Q125*	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, what percentage of this <business/agency/etc.>’s workforce moved from working on-site to working from home? Enter 0 if none. Estimates are acceptable. From <date 1> to <date 2>, what percentage of this <business/agency/etc.>’s workforce moved from working from home to working on-site? Enter 0 if none. Estimates are acceptable.
11	Q126*	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, what percentage of this <business/agency/etc.>’s workforce returned from temporary layoff to working on-site? Enter 0 if none. Estimates are acceptable. From <date 1> to <date 2>, what percentage of this <business/agency/etc.>’s workforce returned from temporary layoff to working from home? Enter 0 if none. Estimates are acceptable.
11	Q127	Being tested	Changes in operations_Changes in hours worked	From <date 1> to <date 2>, how did the total number of hours this <business/agency/etc.>’s <paid> employees worked from home change compared to what was normal before <event>?
11	Q128	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, did any of the following factors limit the ability of this <business/agency/etc.>’s <paid> employees to work from home? Select all that apply.
11	Q129	Being tested	Misc_Product donations	From <date 1> to <date 2>, did this <business/agency/etc.> donate any products as a result of <event>?
11	Q130	Being tested	Misc_Product donations	What was the value of donated products? Estimates are acceptable.
12	Q131	Being tested	Closures and work location_Temporary vs. permanent closures	What is the current state of this <business/agency/etc.>?
12	Q132	Being tested	Changes in operations_Changes in physical/site operations	From <date 1> to <date 2>, did this <business/agency/etc.> experience interruptions to the following services as a result of <event>?
12	Q133	Being tested	Changes in operations_Changes in physical/site operations	From <date 1> to <date 2>, were this <business/agency/etc.>’s <paid> employees unable to access any tools they needed to perform their jobs (such as computers, files, inventory, etc.) as a result of <event>?
12	Q134	Being tested	Changes in operations_Changes in physical/site operations	From <date 1> to <date 2>, how did <utility service interruptions or losing access to these tools> affect this <business/agency/etc.>’s operations?
12	Q135	Being tested	Changes in operations_Temporary changes in business travel	From <date 1> to <date 2>, how did this <business/agency/etc.>’s business travel expenditures for air, rail, car rental or lodging change compared to what was normal before <event>?
12	Q136	Being tested	Changes in operations_Permanent changes to business practices	In <time period 1 (date 1─ date 2)> and <time period 2 (date 3 ─ date 4)>, what percentage of this <business/agency/etc.>’s goods or services were sold using the following methods? Enter 0 if none. Estimates are acceptable.
12	Q137	Being tested	Changes in operations_Permanent changes to business practices	From <date 1> to <date 2>, did this <business/agency/etc.> make any changes to its principal method of selling goods or services as a result of <event>?
12	Q138	Being tested	Closures and work location_Changes in work location / remote work	Does this <business/agency/etc.> have any locations in the area impacted by <event>?
12	Q139	Being tested	Closures and work location_Changes in work location / remote work	Thinking about this <business/agency/etc.>’s <paid> employees that usually work at locations impacted by <event>, from <date 1> to <date 2>, where did these <paid> employees work?
12	Q140	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, how many <paid> employees who usually work on-site did this <business/agency/etc.> shift to working from home as a result of <event>?
12	Q141	Being tested	Closures and work location_Changes in work location / remote work	Thinking of these <paid> employees who have shifted to working from home, in <future time period (date 1 ─ date 2)>, how many of these <paid> employees will continue to work from home?
12	Q142	Being tested	Closures and work location_Changes in work location / remote work	From <date 1> to <date 2>, did this <business/agency/etc.> purchase any equipment or software for <paid> employees to use while working from home as a result of <event>?
Excluded	Excluded	Previously tested by Census Bureau – acceptable	Changes in operations_Changes in level of operations	In your opinion, how much time do you anticipate will pass before this <business/agency/etc.>’s revenues return to what was normal before <event>?
Excluded	Excluded	Previously tested by Census Bureau – acceptable	Changes in operations_Temporary changes in business travel	In <time period (dates) before event>, did this <business/agency/etc.> have business travel expenditures for air, rail, car rental or lodging?
Excluded	Excluded	Previously tested by Census Bureau – acceptable	Closures and work location_Temporary vs. permanent closures	During <time period (date 1 ─ date 2)>, did this <business/agency/etc.> do any of the following for at least one day <as a result of event>? Select all that apply.
Excluded	Excluded	Previously tested by Census Bureau – acceptable	Changes in manufacturing production_Halt in production	In <<time period (date 1 ─ date 2) >/<quarter (month 1 ─ month 2)>>, for how many days did this <business/agency/etc.> cease production <as a result of event>? Enter 0 if production did not cease for at least 1 day.
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, were any of this <business/agency/etc.>’s structures damaged or destroyed as a result of <event>?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, was any of this <business/agency/etc.>’s equipment damaged or destroyed as a result of <event>?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, what was the total dollar amount of the losses for all structures and equipment that this <business/agency/etc.> experienced as a result of <event>? Please include amount before compensation. If none, enter 0. Estimates are acceptable.
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From < future date 1> to <future date 2>, does this <business/agency/etc.> plan to rebuild any of its structures that were destroyed as a result of <event>?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, did this <business/agency/etc.> submit any insurance claims related to <event>?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, did this <business/agency/etc.> submit any insurance claims related to <event> for the following?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, did <event> cause any damage to this <business/agency/etc.>’s structures that was not covered by insurance?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, did <event> cause any damage to this <business/agency/etc.>’s equipment that was not covered by insurance?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	From <date 1> to <date 2>, did <event> cause any losses to this this <business/agency/etc.>’s revenue?
TBD	TBD	To be tested	Misc_Insurance claims for loss of inventory, building damage,	[IF YES] Was any of this lost revenue not covered by insurance?
TBD	TBD	To be tested	Misc_Share of the emergency’s impact covered by insurance, subsidies	What percentage of the damage to structures caused by <event> was covered by this <business/agency/etc.>’s insurance? Estimates are acceptable.
TBD	TBD	To be tested	Misc_Share of the emergency’s impact covered by insurance, subsidies	What percentage of the damage to equipment caused by <event> was covered by this <business/agency/etc.>’s insurance? Estimates are acceptable.
TBD	TBD	To be tested	Misc_Share of the emergency’s impact covered by insurance, subsidies	What percentage of lost revenue caused by <event> was covered by this <business/agency/etc.>’s insurance? Estimates are acceptable.
TBD	TBD	To be tested	Misc_Permits	From <date 1> to <date 2>, was this office unable to issue permits as a result of a closure, lack of staffing, or any other reason?
TBD	TBD	To be tested	Misc_Permits	[If yes] From <date 1> to <date 2>, were permit backlogs caused as a result of a closure, lack of staffing, or any other reason?
TBD	TBD	To be tested	Misc_Permits	[If yes] From <date 1> to <date 2>, were permit backlogs cleared by the end of the reporting month or delayed into a future month?
TBD	TBD	To be tested	Misc_Permits	From <date 1> to <date 2>, did <event> cause this <business/agency/etc.> to delay applying for permits needed to complete work?
TBD	TBD	To be tested	Misc_Permits	From <date 1> to <date 2>, did this <business/agency/etc.> experience any delays from the permit office in receiving permits needed to complete work <as a result of event>?
TBD	TBD	To be tested	Misc_Permits	From <date 1> to <date 2>, did this Building Permit Office change how permits were issues in any of the following ways?
TBD	TBD	To be tested	Emergency preparedness_Emergency management	Before <date/event>, did this <business/agency/etc.>’s <paid> employees receive any emergency preparedness training?
TBD	TBD	To be tested	Emergency preparedness_Emergency management	Before <date/event>, did this <business/agency/etc.> have an emergency response plan in place?
TBD	TBD	To be tested	Emergency preparedness_Emergency management	Before <date/event>, did this <business/agency/etc.> have the following in place?
TBD	TBD	To be tested	Emergency preparedness_Emergency management	From <date 1> to <date 2>, did this <business/agency/etc.> use the following?
TBD	TBD	To be tested	Emergency preparedness_Emergency management	From <date 1> to <date 2>, how often did this <business/agency/etc.> communicate its operating status to key persons, such as <paid> employees, customers, vendors, or suppliers?
TBD	TBD	To be tested	Emergency preparedness_Emergency management	[IF 5 != (NOT AT ALL | NOT APPLICABLE)] From <date 1> and <date 2>, how did this <business/agency/etc.> communicate its operating status to key persons, such as <paid> employees, customers, venders or suppliers? Select all that apply.
TBD	TBD	To be tested	Emergency preparedness_Personnel	On <date>, was this <business/agency/etc.> covered by the following types of insurance?
TBD	TBD	To be tested	Emergency preparedness_Personnel	For <event>, what was the length of the maximum indemnity period in this <business/agency/etc.>’s business interruption policy? A maximum indemnity period is the length of time after an insured event that an insurance company will provide coverage.
TBD	TBD	To be tested	Emergency preparedness_Personnel	Do you think the maximum indemnity period in this <business/agency/etc.>’s business interruption policy will be adequate for <event>?
TBD	TBD	To be tested	Emergency preparedness_Personnel	Did this <business/agency/etc.> have an extended period of indemnity (EPI) option for <event>? An extended period of indemnity is optional coverage that extends the length of time a business is covered by insurance.
TBD	TBD	To be tested	Emergency preparedness_Personnel	[IF 9 = YES] For <event>, what was the length of this <business/agency/etc.>’s extended period of indemnity (EPI) option?
TBD	TBD	To be tested	Emergency preparedness_Personnel	Before <date/event>, did this <business/agency/etc.> have an employee assistance program (EAP) in place that provided staff with free short-term services?
TBD	TBD	To be tested	Emergency preparedness_Personnel	From <date 1> to <date 2>, did this <business/agency/etc.> promote any employee assistance program (EAP) services to its <paid> employees?
TBD	TBD	To be tested	Emergency preparedness_Personnel	From <date 1> to <date 2>, how did the number of <paid> employees using this <business/agency/etc.>’s employee assistance program (EAP) change compared to what was normal pre-<event>?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	On <date>, did any of the structures in which this <business/agency/etc.> operates sustain the following kinds of damage as a result of <event>?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	[IF YES TO ANY IN 13]. Which parts of the structures sustained physical damage as a result of <event>? Select all that apply.
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	[IF YES TO ANY IN 13] What caused damage to the structures? Select all that apply.
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	Before <date/event>, did this <business/agency/etc.> have a plan to continue operating if its structure(s) could not be accessed?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	Before <date/event>, did this <business/agency/etc.> have a plan to continue operating without access to equipment it typically uses?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	Before <date/event>, did this <business/agency/etc.> have a plan in place to continue operating without one or more utilities, such as electricity, gas, water, internet, or telecommunications?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	Before <date/event>, did this <business/agency/etc.> conduct a business impact analysis? A business impact analysis is used to assess the importance of different business activities and the resources/processes needed to return to operations after a business disruption.
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	Before <date/event>, did this <business/agency/etc.> have a business continuity plan in place? A business continuity plan contains critical information an organization needs to continue operating during an unplanned event.
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	[IF YES TO 18] Before <date/event>, did this <business/agency/etc.> conduct exercises to evaluate the effectiveness of its business continuity plan?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	<Between <date> and <date>/On <date>>, did this <business/agency/etc.> use any of the following information from its business continuity plan?
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	<On <date>/Between <date 1> and <date 2>>, which of the following did this <business/agency/etc.> experience as a result of <event>? Select all that apply.
TBD	TBD	To be tested	Emergency preparedness_Physical surroundings/Building construction	<On <date>/Between <date 1> and <date 2>>, how successful was this <business/agency/etc.>’s business continuity plan at minimizing disruptions <resulting from <event>>?
TBD	TBD	To be tested	Emergency preparedness_Systems protection	Before <date/event>, did this <business/agency/etc.> have a plan for storing electronic business records <in case of <event type>>?
TBD	TBD	To be tested	Emergency preparedness_Systems protection	<On <date>/Between <date 1> and <date 2>>, were any of this <business/agency/etc.>’s electronic business records compromised as a result of <event>?
TBD	TBD	To be tested	Emergency preparedness_Systems protection	<On <date>/Between <date 1> and <date 2>>, did this <business/agency/etc.> have a backup of its electronic business records?
TBD	TBD	To be tested	Emergency preparedness_Systems protection	How often does this <business/agency/etc.> back up the following?
TBD	TBD	To be tested	Emergency preparedness_Systems protection	<On <date>/Between <date 1> and <date 2>>, did this <business/agency/etc.> lose any of the following as a result of <event>?