2. 
3. Questionnaire
   A Questionnaire to help determine the activities where definitive guidance should be provided via the Restore Chester County Task Force.
4. 
6. Name*
7. Email Address*
9. Address
11. City
12. State
13. Zip Code
15. Phone Number*
16. Fax Number
18. Responding as:*

    1. Individual
    2. Government Entity
    3. Office -- Business
    4. Manufacturing -- Business

    1. Medical Facility
    2. Religious Facility
    3. Non-Profit
    4. Sports Facility
19. Type of Government Entity*

    1. Federal
    2. State
    3. County
    4. City

    1. Township
    2. Borough
    3. K-12 School
    4. College/University
21. Type of School*

    1. Public
    2. Charter
23. Organization Name*
27. Source of Covid-19 reopening Information*

    Check All that Apply

    1. Broadcast Television
    2. Cable Television
    3. Internet Video
    4. Print Media
    5. Chester County Health Web/E-Mail

    1. Pennsylvania Health Web/E-Mail
    2. CDC Web/E-Mail
    3. Restore Chester County Web
    4. Trade Association

    1. General Social Media
    2. Informal Peer Network
    3. Municipality
    4. None
29. Name of Trade Association*
33. Type of Activity*
34. Number of Participants at Peak Time*
35. Known Capacity Limits*
37. Venue*

    1. Indoor

    1. Outdoor

    1. Both
39. Dates

    1. One-Time
    2. Recurring
    3. Continuous
40. Scheduled Date
    Scheduled Date
41. Date Range
    Date Range Start Date

    —

    Date Range End Date
43. Recurring
    Recurring Start Date

    —

    Recurring End Date
44. Recurring Pattern

    1. Weekly Monday
    2. Weekly Tuesday
    3. Weekly Wednesday
    4. Weekly Thursday
    5. Weekly Friday
    6. Weekly Saturday

    1. Weekly Sunday
    2. Daily
    3. Daily Mon-Fri
    4. Daily Mon-Sat
    5. Monthly
46. Description of Activity*
48. Mitigation Plan*
    What Mitigate steps are planned and how does the organizer plan to manage them.
50. Do you contemplate any message points for event/activity you have not used in the past?.
54. General Questions/Concerns/Information needs
    Please list any questions and information you need to continue planning
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field