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Tue, 2014-01-07 09:23 — Florence Gibert
| Section | Questions | Extras | Answers |
|---|---|---|---|
| Identification | Entered by (name) | ||
| Name(s) and age(s) of individual(s) at location being described (list primary contact person first) | |||
| Contact info and preferred method (phone #, email address, etc) | |||
| Organization of person being surveyed (if appropriate) | |||
| Type of location being descibed | |||
| Other | |||
| Location name (if appropriate) | |||
| Size of population covered by survey | |||
| Street Address | |||
| City | |||
| Location | |||
| Housing | What is the status of the housing units you are assessing for the current population over the next year? | ||
| What is the status of the housing units you are assessing for the current population over the next 20 years? | |||
| Environmental Health and Safety | What is the general status of residents in terms of mitigating mold growth and other hazards in their living and working environment? | ||
| Shelter and Evacuation Systems | What is the status of residents in terms of ability to shelter in place safely, if facing a crisis the same size or greater than Sandy? | ||
| What is the status of residents in terms of access to appropriate, nearby, alternative housing available to residents in need to evacuate their homes? | |||
| Supply Chains | What is the status of the community in terms of ability to address all of the residents’ material and retail needs (are they stable, local and regional?) | ||
| What is the status of the community in terms of susceptibility to material needs disruption? | |||
| Energy | What is the status of residents in terms of ability to keep warm in cold conditions and keep cool in hot conditions? | ||
| What is the status of residents in terms of access to sufficient and reliable electricity? | |||
| What is the status of residents in terms of access to off grid, micro-grid, and renewable energy solutions? | |||
| Food Security | What is the status of residents in terms of food security? | ||
| Clean Water | What is the status of residents in terms of access to clean drinking water? | ||
| Hygiene and Prevention | What is the status of residents in terms of enduring hygiene and disease prevention? | ||
| Sewer Systems | What is the status of residents in terms of human waste management and sewage systems? | ||
| Waste Management | What is the status of residents in terms of solid waste management (trash removal, recycling, etc)? | ||
| Health Services | What is the status of residents in terms of access to good quality health care at an affordable cost? | ||
| Psychosocial Resilence | What is the status of residents in terms of feeling supported emotionally and psychogically by their community? | ||
| Communication Systems | What is the status of the community in terms of capacity to communicate effectively in normal times as well as in an emergency compromising central grid communications and computing? | ||
| Transportation | What is the status of the community in terms of appropriate access to mass transportation in emergency conditions? | ||
| Coastal Protection Infrastructure | What is the status of the community in terms of appropriate coastal protections in place to protect from flooding? | ||
| Community Security | What is the status of the community in terms of social injustice and security? | ||
| Social services | What is the status of the community in terms of having current services able to address social problems emerge through individual or collective challenges? | ||
| Community Commons Areas | What is the status of the community in terms of having the facilities and resources to enable community-based organizations and residents in need to meet and solve problems? | ||
| Viable Value Chains | What is the status of residents in term of facing economic challenges? | ||
| What is the status of residents in term of accessing local jobs? | |||
| What is the status of the community in term of having adequate anchor institutions (e.g. hospitals, colleges, manufacturing, information services) participating in improving the economic conditions, employment, resilience, and sustainability of the community? | |||
| Mitigation and Transformation | What is the status of the community in term of advancing more resilient and sustainable systems? | ||
| What is the status of the community in term of moving toward 100% renewable energy? | |||
| What is the status of the community in term of increasing the effectiveness of community gardens and local farms to produce food locally? | |||
| Resident(s) at the location being described would like a referral for case management assistance | Case Management help with (select all that apply) | Housing | |
| Environmental health and safety | |||
| Shelter and evacuation systems | |||
| Supply chains | |||
| Energy | |||
| Food security | |||
| Clean water | |||
| Hygiene and prevention | |||
| Sewer systems | |||
| Waste management | |||
| Health services | |||
| Psychosocial resilience | |||
| Communication systems | |||
| Transportation | |||
| Coastal protection infrastructure | |||
| Community security | |||
| Social services | |||
| Community commons areas | |||
| Viable value chains | |||
| Migration and transformation | |||
| Other |
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