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Family Resource Survey
 

 

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FAMILY RESOURCE SURVEY                                                           Date_________________

Family name_______________________________________________________________________

Address____________________________________________________________________________

Home telephone____________________________________________________________________

Work telephones___________________________________________________________________

Name

Age

Drives

Cell phone

Email

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equipment

 

___construction equipment

___camp stove

___hand tools

___Dutch oven   how many:       sizes:

___truck   kind:

___solar oven

___4-wheel drive vehicle   kind:

___alternate heat source

___RV    kind:

___wood burning fireplace

___tow truck

___log splitter

___trailer   size:

___72 hour kits  how many:

___boat   size:

___auto emergency kit

___snow blower

___rototiller   size:

___generator   size:

___yard tractor

___swimming pool

___gardening tools

___chain saw

___greenhouse

___extra saw chains

___freezer   size:

___CB radio

___dehydrator

___ham radio

___water bath canner

___walkie talkies

___pressure canner

___fishing equipment

___other canning equipment:

___hunting rifle

___sewing machine

___tent   size:

___serger

 

Skills

 

___nurse

___carpentry

___doctor

___plumbing

___dentist

___electrical

___trained EMT

___hunting

___CPR trained

___fishing

___counselor

___butchering

___lawyer

___gardening

___heavy equipment operator

___canning

___ham radio operator

___sewing

 

Living storage

 

___animals   kind:

___nut trees   number:         kind:

___fish   kind:

___berries   kind:

___poultry   kind:

___grapes

___garden   size:

___spring-fed well

___fruit trees   number:         kind:

 

 

Home storage

 

___food   how much:

___library

___water   how much:

___seeds for planting

___medical supplies

___root cellar

___extra clothing

___basement   what kind:

___sewing supplies

___emergency savings

___emergency fuel supplies

 

 

Special Needs:

 

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Copyright 2004 - 2013 Cheryl Driggs
Last modified: 07/15/2013