Toggle navigation Load unfinished survey Resume later Exit and clear survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. Shelter Location This survey is for Local Emergency Management Coordinators and Shelter Operators. Please answer all questions to the best of your ability. There are four pages of questions, with 22 questions total. Please take the next 10-15 minutes to fill out this survey. There are 22 questions in this survey. Your Information Please include your contact information. (This question is mandatory) First and Last Name: (This question is mandatory) Email Address: Work Phone: Mobile Phone: Are you the Local Emergency Management Coordinator for the Municipality/Township/Borough the shelter is located in? Yes No Shelter Information Please answer all questions. (This question is mandatory) Shelter Name: (This question is mandatory) Address: Municipality: Main Contact for Shelter. Please include full name, email address, and phone number. This can be the Local EMC, shelter manager, or building contact. Shelter Plan: If you have a shelter plan, please upload here. Please upload at most one file Upload file Title Comment File name × Upload file Capacity: Only numbers may be entered in this field. Shelter Type: Check all that apply Emergency Shelter Temporary Housing Other Shelter Capabilities/ Accommodations Please answer to the best of your ability. ADA Compliant: Yes No No answer Pet Friendly: Yes No No answer Backup Generator: Yes No No answer Public Transportation Access: For individuals who use public transportation, is the walk from a bus stop to the shelter reasonable? Yes No No answer Cooling Center: Yes No No answer Warming Center: Yes No No answer Emergency Contact Please include an emergency contact for the shelter. A 24 hour available number should be provided. Emergency Contact Full Name: Phone Number: Back up Emergency Contact: Back up Contact Phone Number: Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
