COVID-19 Tracker

In efforts to track the impact of COVID-19 on your business, we have created a system for tracking key metrics.

please fill out the form below as completely and with as much detail as possible.

Company Name: (Official Names Only, No Casual References Please.)

Location of Facility: (Precise Street Address Only ie. "123 Filter Ave")

Is the Currently Facility Open?:
yes no

Number of Employees On Site:

Net Change from Last Week: (Number Only. ie. Number of Employees Last week +/- This Week)

Is The Number Of Hours Per Shift Being Reduced From Normal Operation?:
yes no

Is the Facility Deploying Alternating Shifts?:
yes no

Is the Facility Reducing Number of Hours Worked?:
yes no

Number of Employee Absent Due To Self Quarantine:

Number of Employees Working From Home:

Number of Employees Furloughed Due To Lack of Work:

Number of Employees Confirmed With COVID-19:

Number of Employees Recovered From Confirmed Diagnosis:

How Are You Mitigating the Impact To Your Business?: (Please provide as much detail as possible)

Are You Experiencing Staffing Shortages?: (Please provide as much detail as possible)

Are You Experiencing Supply Chain Issues?: (Please provide as much detail as possible)

What Communications Are You Receiving About Customer Interruptions?: (Please provide as much detail as possible)

What Other Issues Are You Experiencing?: (Please provide as much detail as possible)

How can Madison Help You In This Current Situation?: (Please provide as much detail as possible)