CF DISASTER 2021 Interview SheetDate:(Required) MM slash DD slash YYYY Completed By:(Required) First Last Business Identification1. Are you an existing member of any of these organizations? Chilliwack Chamber of Commerce Downtown Chilliwack BIA The City of Chilliwack Sto:lo Community Futures Community Futures South Fraser Chilliwack Tourism Other Local Businesses2. Business Name:(Required)3. Business Address:(Required) Street Address Address Line 2 Town Postal Code 4. Cell Phone:5. Contact Phone:(Required)6. Contact Name:(Required) First Last 7. Email:(Required) 8. Best Contact Method Currently:(Required) Cell Phone Contact Phone Email9. Is your business identified as one or more of the following groups? Indiginous owner or led Women owned or led Youth owned or led Owned or led by a person with a Self Disclosed Disability Owned or led by a Recent ImmigrantThis question is important as it may lead to different funding opportunities.10. Type of physical location?(Required)11. How long has your business been in operation?(Required)Years12. What is your business structure?(Required)13. Total number of employees at your business before floods?(Required)Full-TimePart-TimeSeasonalOther Add Remove14. Type of Business?(Required)Please specify your sector15. Were you impacted by previous Disasters (Floods, Slides, Wildfires)?(Required) Yes NoIf so, which year(s)?16. Were you impacted by recent flood restrictions and closures?(Required) Yes NoIf 'yes', please describe how you were impacted by BC Flooding:17. How has your business been impacted? Please explain how your business has been impacted below.18. What are your immediate needs? Please describe them below.Please specific additional details of any immediate needs below.20. What resources do you believe you will need within the next few weeks to year? Please describe below in greater detail any resources you will need in the next few weeks to a year.21. We are aware that challenges like floods and wildfires can have an impact on businesses. Repeated challenges can compound for some individuals. Please consider the following by ranking from 1 (little impact) to 10 (heavy impact):(Required)OwnersEmployeesCustomers Add RemoveEmployees22. Have you laid off or terminated any employees post disaster?(Required) Yes NoHow many employees do you have now?(Required)Have Records of Employment (ROEs) been issued?(Required) Yes NoDo you have an expected date of recall?(Required)23. What is the status of your employees?How many impacted?24. Were you able to help your employees deal with the situation? (Excluding the employment impact)Type of help?25. Will employees need assistance?What type of assistance?26. Does your business employ temporary foreign workers? If yes, what specific needs are they experiencing as a result of the disaster?TaxesSource Deductions Current Due Overdue UnsureGST Current Due Overdue UnsurePST Current Due Overdue UnsureCorporate or Personal Current Due Overdue Unsure28. Have you filed a RC4288 to Revenue Canada? Yes No29. Have you filed a Note with the Minister of Finace? Use etax portal. Yes NoCritical papers, business records and policies30. Are your critical papers/records secure/backed up? Yes NoWhat type and where?(Required)Do you need help to access? Yes No31. Do you have business insurance? Yes No32. Does your business insurance cover water, slide, fire, smoke damage losses? Yes No33. Does your business insurance cover loss of income, inventory and/or interruption of business? Yes No34. Do you have a strategic plan? Yes No35. Do you have a budget or cash flow projection? Yes No36. Do you have an emergency, contingency or recovery plan? Yes NoDistribution Channels and Supply Chain37. Have you advised your customers to the status of your business? Yes NoIf yes, how did you advise them?38. Do you have a supplier, or wholesaler list to advise them of the status of your business? Yes NoIf yes, how did you advise them?39. Have you had challenges obtaining goods or supplies? Yes NoDate of Evacuation AlertDate of Highwway ClosuresDate of Evacuation OrderDate of Travel BansDate of LossFinancial Statements Yes NoTax Returns – personal, business, corporate, GST, PST, Excise, other Yes NoPayroll Records Yes NoT4s from Previous Year Yes NoBusiness Plan Yes NoCashflow Projections Yes NoBusiness Continuity Plan Yes NoPhotos of the Business. May include Social Media posts and images (used to prove assets existed). Yes NoDocumentation is critical - SAVE RECEIPTS!!42. Do you have a GoFund Me set up? Yes NoAre you aware that fees are 20 – 25%+? And, that this is taxable income? Yes NoCommentsFollow up43. We are working together to find funding and resources for businesses affected by the flood. Who can we Connect you with? Chilliwack Chamber of Commerce Downtown Chilliwack BIA The City of Chilliwack Sto:lo Community Futures Community Futures South Fraser Chilliwack Tourism Other Local BusinessesReferrals44. Do you know who else we should contact? Provide below name, email, phone numbers.45. Will you share our contact info with others that you think may need help? Yes NoComments46. Anything else you'd like to share?
