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Business Contact Information for COVID-19 Response

  1. Does your business have multiple locations?
  2. Will there be a different person to contact for the different locations?
    If you answer "Yes," additional questions will become available near the end of the form. Please make sure to fill out the contact information for additional locations there.
  3. Type of business/workplace
  4. Size of business/workplace
  5. Our business has a COVID Safety Plan in place (for each location, if multiple)
    Safety plans do not need to be submitted for review, but must be available on-site and be shown during inspection by any regulatory agency.
  6. Include first and last name
  7. This should be a number we can reliably reach them at, so please do not include general store numbers or phone trees.
  8. Leave This Blank:

  9. This field is not part of the form submission.