Supplier Coronavirus Impact Assessment

1. First Name*
2. Last Name*
3. Job Title*
4. Company*
5. Email Address*
6. Telephone Number 1*
7. Telephone Number 2*
8. Are you currently experiencing disruption in your ability to supply products/services?*
  
  Yes
  
  No
9. If YES, please briefly describe the nature of this disruption, including the cause and the impact
10. Do you believe your ability to supply products/services is likely to be disrupted within the next four weeks?*
  
  Yes
  
  No
11. If YES, please briefly describe the nature of this disruption, including the cause and the impact
12. Please describe what mitigation measures you are taking (if any) in order to ensure the continued supply of your products/services.
13. If you have any additional information you would like us to know, please tell us here.