Post by Berta on Nov 29, 2007 12:58:16 GMT -8
Here is a copy of the community resource survey that Eastridge had used at one time. Their new survey is online at the school's website.
Sample Community Resource Survey
EAST RIDGE ELEMENTARY SCHOOL EMERGENCY SURVEY FORM
Name______________________________________
Address____________________________________
Phone______________________________________
E-Mail_____________________________________
I live within walking distance of the school.
I am available during the day to provide assistance during an emergency or disaster.
If you wish to participate, please check all appropriate lines and identify who in your household has these skills:
First Aid: Describe
I'm a doctor. ___________________________________________________
I'm a nurse. __________ __________________________________________
I'm certified in first aid. ___________________________________________
I have completedć the CERT (Community Emergency Response Training) program
and I would like to support:
___Medical
___Search & Rescue
___Fire Suppression
___Logistics
Food and Shelter:
___ I will serve food and water.
___ I will help assemble shelters and toilets.
Care:
___ I will be of assistance to children (read, comfort, play)
___ I have older children who may be willing to assist others.
Communications:
___ I am a Ham Radio Operator and have access to a radio.
___ I will help in reuniting parents and children.
___ I have walkie-talkies.
___ I have additional communication resources.
Describe______________________________________________________________
Skills:
Please indicate your working skills from the list below. Remember, in a disaster, you may be asked to put these skills to use.
____Auto Mechanic ____Telephone Repair ____Construction ____Fire Suppression
____Plumbing ____Heavy Equipment ____Social Work ____Engineering: __________
____Electrical ____Survival Training ____Search & Rescue
Resources:
I have access to heavy duty equipment such as: _________________________________________________________________
(pick up or flatbed truck, tow truck, bulldozer, winch, snow plow, other)
I will help in other ways (clearing rubble, etc.) _________________________________________________________________
I have access to fuel. (propane, gasoline, etc.) _________________________________________________________________
I have access to other items: __________________________________________________________________
(lumber, chain saw, wheelbarrow, tools, camping equipment, other)
I have access to alternate transportation (horse, motorcycle, riding lawnmower with trailer, etc.).
_____________________________________________________________________
Sample Community Resource Survey
EAST RIDGE ELEMENTARY SCHOOL EMERGENCY SURVEY FORM
Name______________________________________
Address____________________________________
Phone______________________________________
E-Mail_____________________________________
I live within walking distance of the school.
I am available during the day to provide assistance during an emergency or disaster.
If you wish to participate, please check all appropriate lines and identify who in your household has these skills:
First Aid: Describe
I'm a doctor. ___________________________________________________
I'm a nurse. __________ __________________________________________
I'm certified in first aid. ___________________________________________
I have completedć the CERT (Community Emergency Response Training) program
and I would like to support:
___Medical
___Search & Rescue
___Fire Suppression
___Logistics
Food and Shelter:
___ I will serve food and water.
___ I will help assemble shelters and toilets.
Care:
___ I will be of assistance to children (read, comfort, play)
___ I have older children who may be willing to assist others.
Communications:
___ I am a Ham Radio Operator and have access to a radio.
___ I will help in reuniting parents and children.
___ I have walkie-talkies.
___ I have additional communication resources.
Describe______________________________________________________________
Skills:
Please indicate your working skills from the list below. Remember, in a disaster, you may be asked to put these skills to use.
____Auto Mechanic ____Telephone Repair ____Construction ____Fire Suppression
____Plumbing ____Heavy Equipment ____Social Work ____Engineering: __________
____Electrical ____Survival Training ____Search & Rescue
Resources:
I have access to heavy duty equipment such as: _________________________________________________________________
(pick up or flatbed truck, tow truck, bulldozer, winch, snow plow, other)
I will help in other ways (clearing rubble, etc.) _________________________________________________________________
I have access to fuel. (propane, gasoline, etc.) _________________________________________________________________
I have access to other items: __________________________________________________________________
(lumber, chain saw, wheelbarrow, tools, camping equipment, other)
I have access to alternate transportation (horse, motorcycle, riding lawnmower with trailer, etc.).
_____________________________________________________________________