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Business Damage Assessment Survey (Fields marked with * are required)

Providing information in the fields below submits a survey to determine damage related to disaster impacts in Florida, and does NOT serve as an application for resources. To apply for disaster loans and resources, click on the RECOVER tab. After filling out the survey, federal, state or local agencies may reach out to you through the contact information provided if you indicate your interest.

Surveys are public records and must be made available to the public and media upon request.

Contact Details:
Yes
No
Alternate location
Alternate hours
When do you anticipate re-opening?
What are your biggest challenges to re-opening?
Lack of Power
Physical Damage to Business Location
Access to Business Location
Employees Unavailable
Suppliers Unavailable
Others
If other, Please Specify
Please check all types of insurance you have for your business:
Property Insurance
Inventory Insurance
Flood Insurance
Business Interruption Insurance
Physical Damage:
(Physical damages include repair or replacement of real property, machinery, equipment, fixtures, or inventory)
Did this location suffer physical damages?
Total personal property/inventory loss (in dollars):
Total estimated real estate loss (in dollars):
Estimated cost to remove trees or debris (if applicable):
Did your business get damaged by flooding?
Yes
No
Is your property located in a flood zone?
Yes
No
What was the water height above the finished first floor (inches or feet)?
Does your business have a basement?
Yes
No
What was the water height in the basement (inches or feet)?
If your business is not usable, what type of space do you require?
Square feet needed:
Estimated length of time needed (approximate number of days):
Economic Damage:
(Economic damages include the inability to meet necessary financial obligations, such as payroll or rent)
Did this location suffer economic damages?
Did you lose business due to this emergency/disaster?
Yes
No
Unsure
Start Date
End Date
What were your business revenues during the disaster period?
What were your business revenues during the same period of the prior year?
Please estimate the total cost(physical and economic) to your business due to this emergency/disaster:
How many employees (Full Time and Part Time) do you currently have?
Have you or will you lay off employees as a result of this emergency/disaster?
Yes
No
Number of temporary lay-offs:
Number of permanent lay-offs:
Do you sell food products?
Yes
No
Have you registered for disaster assistance with FEMA?
Yes
No
If you have not registered with FEMA, please visit www.DisasterAssistance.gov
Other key factors hindering business operations (check all that apply)
Debris Removal
Insurance Settlement
Product Supply
Short Term Capital
Access to Business
Water Damage
Long Term Capital
Construction/Contractor Needs
Training/Personnel
Employee Transportation
Customer Base
Financial/Business Loans
Would you like to be contacted with more information about business relief services and programs?
Yes
No
Check the types of assistance your business is interested in receiving:
Emergency Bridge Loan - A short-term, interest-free loans up to $50,000 available to small business owners who have between 2 to 100 employees, have been in operation for at least one full year and have experienced physical or economic damage.
SBA Physical Disaster Loans - Loans are available to qualified applicant businesses of any size for uninsured losses up to $2 million to repair or replace business property to pre-disaster conditions. Loans may be used to replace or repair real estate, equipment, fixtures and inventory and leasehold improvements.
SBA Economic Injury Loans - Loans up to $2 million are available for small businesses that sustain economic injury as a direct result of a disaster. These working capital loans are made to businesses without credit available elsewhere to help pay ordinary and necessary operating expenses that would have been payable barring the disaster.
Small Business Development Center Business Counseling - Certified business analysts will provide general business counseling to help access traditional SBA loans.
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