Please fill out the survey below. We may use this information to contact you during a real event or an exercise to ask if you are able to assist with staff, facility space, equipment or supplies.
Please know that filling this out IN NO WAY obligates you or your facility/organization to providing these resources. It simply gives us a starting point to ask for help if a disaster were to occur, and will aid us during exercises to practice this process.
If your facility is not listed in the drop-down list below, it might be because someone else at your facility has already completed this questionnaire as we are sending it out to everyone at your facility who is registered on the coalition's website. If that is not the problem, please contact Angela at email@example.com for help.
In each category, please check all of the resources you and your facility may be able to provide during a disaster.
During a disaster, we would use this list to call or email you and ask if you are able to provide this resource. There is no obligation to you or your facility to provide this resource at any time.
Please check all that may apply or check none at the bottom.
Fixed Staff are staff members who are unable to leave your facility but may still be available to help during a disaster.
Mobile Staff are staff who might be able to leave your facility to assist during a disaster.
Again please check all that apply.
Please check all that may apply or check none at the bottom. Keep in mind we are only asking about your facility possibilities here. We may be able to bring staff from other locations.