Florida SERT

Business Damage Assessment Survey

The information provided in this survey will be shared among various state and local agencies to expedite implementation of appropriate disaster relief programs for businesses. This survey assists the State with determining if relief services for businesses should be activated.

Fields marked with a * are required.

Event/Incident: *
Business Name: *
Location Name or Identifier: *
Federal Tax ID (FEIN):
State Tax ID:
Address 1: *
Address 2:
City: *
County: *
State: *
Zip Code: *
Contact Name: *
Contact Email: *
Contact Phone No.: *
1) Type of business?
If Other, Please Specify:
2) Currently Open For Business?
Yes No Open in Alternate Location
2a) If no, when do you anticipate reopening?
3) Did your business suffer damage?
Yes No
3a) If yes, was the of type damage suffered?
4) Did you or will you lose business due to this emergency/disaster?
Yes No
5) Do you have an estimate of the cost to your business due to this emergency/disaster?
Yes No
5a) If yes, how much?
6) How many employees (Full Time and Part Time) do you currently have?
7) Did you lay-off employees, or will you lay off employees?
Yes No
7a) If yes, number of temporary lay-offs?
7b) Expected or approximate lay-off period in days?
8) Have you registered with FEMA?
Yes No

If you have not registered with FEMA, please visit www.disasterassistance.gov.

9) Other key factors hindering business operations:
Access to business Debris removal Product Supply
Financial / business loans Short-term capital Long-term capital
Training / personnel Water damage Insurance settlement
Employees' transportation Customer base Construction / contractor needs
10) If your business space is not usable, what type of space is required?
Office Industrial Flex Retail None
Square feet needed:
Length of time needed: (Approx Days)
11) Would you like to schedule an appointment for access to business relief services and programs?
Yes No
Check types of assistance your business is interested in receiving:
Emergency Bridge Loan
A short-term loan (90 to 180 days) up to $25,000 available to small business owners who have between 2 to 100 employees, have been in operation for at least one full year and have verifiable, physical damage to their business.
SBA Physical Disaster Business Loans
Loans are available to qualified applicant businesses of any size for uninsured losses up to $2M 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 Disaster Loans (EIDLs)
Loans up to $2M 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.

Enter the code above here:
Can't read the image? click here to refresh