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Survey of Small Business Owners
(If you prefer to Mail or Fax this survey, you may Download the Survey Form and print it out.
 You will need the Adobe Acrobat Reader which is free.)

  1. Is your company a ... ?
    Partnership
    Sole Proprietorship
    "C" Corporation
    "S" Corporation
    "LLC" Limited Liability Corporation
    Other (specify):
  2. Is your company ...?
    Majority Interest Women-Owned 
    Majority Interest Minority-Owned
    Not Applicable
  3. Please identify your position in the business:
    Majority Interest Owner     
    Minority Interest Owner
    President / CEO
    Partner
    Sole Proprietor / Principal
    Other (specify):
  4. Which of the following applies to your business:
     Personally started the business
    Purchased the business from someone else
    Inherited the business or it was transferred in some other way
  5. At the current time, how many people are employed at all locations in your business?
    Part-time (30 hours or less)
    Full-time
    Total Employees
  6. In what county and city is your business located? 
    County:       City:
  7. At this point in time, what do you consider your primary goal as a person who owns and manages a business?
  8. From your perspective as an owner who also manages the business, what are some of the primary factors that help make a small business successful?
  9. What would you say are the greatest challenges that a successful small business owner must face?
  10. Please check the appropriate response to how much of a threat it is to you and the success of your business at this point in time. Would you say it would be very much of a threat, somewhat of a threat, or not too much of a threat?
     

    Very
    Much Of
    A Threat

    Somewhat
    Of
    A Threat

    Not Too
    Much Of
    A Threat

    No
    Response

    a.

    Attracting or recruiting new employees

    b.

    Enhancing customer service

    c.

    Improving product or service quality

    d.

    Building market share

    e.

    Controlling health care costs

    f.

    Building acceptable personal wealth

    g.

    Maintaining continued growth

    h.

    Improving profitability

    i.

    Access to capital

    j.

    Retaining current key employees

    k.

    Government Regulations & Paperwork

  1. Does the business own or lease its primary place of operation? 
    own     lease
  2. Is the primary place of the business’ operations located in (your / the owner’s) home?
    Yes     No
  3. Which of the following business sectors would be most appropriate in which to classify your company?
    Manufacturing Construction Retail
    Transportation Insurance Financial Services
    Real Estate Business Consulting Communications
      Computer / Technology   Other service to businesses   Health Care
    Other (specify):
  1. Which of the following regulation areas most affects your business?
    Environmental  Transportation Insurance
    Health Department  Labor  OSHA
    Workers' Compensation    Other
  1.  Overall, how has government regulatory requirements affected your small business?
    Helped Significantly  Helped Somewhat  No Effect
    Hurt Somewhat  Hurt Significantly
  1. In the past five years, have you been fined for violating federal or state regulations?
    Yes     No
  2. If yes, How much was the fine? 
  3. Did you appeal? 
    Yes     No
  4. What was the result?
  5. What actions do you think are necessary in order to make the regulatory process easier and more effective for your company?
  6. What can government "Do or Not Do" to help your business grow and be successful?
  7. Are you willing to work on a committee to help with Small Business Advocacy Issues? 
    Yes     No

Subcommittee / Issue Areas 
(Rank 1,2,3 the areas that you are most interested):

Capital Formation   Regulation & Paperwork   Taxation
Human Capital Environmental Policy Procurement
International Trade   Innovation / New Economy   Technology
Insurance: Health / Workers' Compensation
  1. If yes to question 21, or you would like to be added to our mailing list, please complete the following:
    Name:
    Company
    Name:
    Address:
    City:
    State :      Zip
    Phone:
    Fax:
    Email:

    
NOTE: You must press the Submit Button to send this form.

Copyright © 2004
Commonwealth of Kentucky

Kentucky Commission on Small Business Advocacy
W. James Host, Executive Director
Bobby Clark, Chair & Norma Taylor, Vice-Chair

Kentucky Commerce Cabinet
24th Floor, Capital Plaza Tower
500 Mero Street
Frankfort, Ky. 40601
Phone:  502-564-4270
Fax:  502-564-1512