Resident Questionnaire

Questionnaire pic
Resident Questionnaire

In order to have a successful neighborhood emergency plan, it is important to know the people in our community.   By compiling profiles of our neighbors, their personal skills and resources, it will allow our community to implement a neighbors helping neighbors emergency plan during and following a disaster in our area.
Your information will only be used for the purpose of our SPM-EP with the database  created to be called upon in the event of a disaster. Please provide as much information as you would like the SPM-EP data bank to have on file.  Participation is voluntary; however, we strongly suggest that you and your family be a part of our community emergency plan as we will need the support of each other in an emergency.

Please follow one of the links below, provide the information as shown, and return to any of the locations shown on the bottom of the PDF form, or respond directly on-line.

Thank you!

Resident Questionnaire (PDF)

Resident Questionnaire (On-Line)

South Parrett Mountain Emergency Plan (SPM-EP) - Neighborhood Disaster Resource Inventory

Address of your home:
Occupants of your home:
Are there people in your home with mobility needs?:
Pet & livestock inventory (indicate quantity):
Can you provide assistance with transporting and/or housing animals?:
Would you be able to house neighbors if it's required because damage made their home uninhabitable?:
Would you be willing to provide daily care in your home for:
Do you have a large building such as a shop, barn, etc., that you would allow use for triage, shelter, or gatherings?
Equipment & supplies you can share:
Personal skills you can offer:
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