XPIRED: COVID-19 Outreach Response Form

Organization *

Primary Contact *

(Or the person you spoke with)

Staff Name *

(Who contacted the business?)

Enter required value Holly Allen Linda Ashworth Linda Baker Marcia Bostick Scott Euton Robin Feather Gail Johnson Stephanie Keinath Sarah Alice Keiser Chris Kershner Logan Marcum Phil Parker Carla Pennington Barb Prater Dick Reardon Jenna Robbins Lisa Sample Sylvia Stahl Belinda Matthews Stenson Jessica Wagner Barbara Wiford LaDonna Wulfeck

Communication Method *

Enter required value Phone Email Both

Is this an essential business? *

Enter required value Yes No

Essential Business Details

(What makes this an essential business?)

Employees Working Virtual *

(Are any employees operating remotely or working from home?)

Enter required value Yes No

Virtual Employee Details

(Are some/all working remotely, some/all working on-site, none working?)

Business Insight *

Have they been participating in webinars or virtual gatherings to gain insight?

Enter required value Yes No

List any specifics about the resources they are using

Business Needs *

(List anything they indicated their business needs to survive the crisis)