NEIGHBORHOOD RESOURCE SURVEY                                                Date_____________

Section #__________ Section Leader ________________________________________________________________

 

Address __________________________________________________________________________________________________
Household name __________________________________________________________________________________________
Adults' names ____________________________________________________________________________________________
Children, names and ages  __________________________________________________________________________________
__________________________________________________________________________________________________________
Phone numbers - Home _______________________________ Work   ______________________________________________
                               Cell   _____________________________________________________________________________________
Out-of-state contact and phone ______________________________________________________________________________
 
 
Equipment Skills
_____construction equipment _____nurse
_____generator _____doctor
_____boat _____dentist
_____pick-up truck _____lawyer
_____trailer _____psychologist
_____tow truck _____school counselor
_____swimming pool _____radio operator
_____CB radio _____heavy equipment operator
_____ham radio _____licensed truck or bus driver
_____chain saw _____trained EMT
_____tent, size _____CPR trained
  _____firefighter
  _____policeman
  _____plumber
  _____electrician
  _____locksmith
  _____carpenter
  _____roofer
  _____arborist

 

Special Needs:

Health:

Language:

Other: