Request edit access
Riverview Emergency Resources Survey
This survey was created to identify individuals within the Riverview neighborhood who are potentially willing and able to collaborate with town officials in developing effective response plans and executing protocol in the event of an emergency (tornado, fire, earthquake, storms, man-made disasters, etc). We currently define "executing protocol" to mean that these individuals might be asked to serve as a support person for a neighbor in an informal "buddy" system within their neighborhood should a the need arise.

Please take a moment to fill out the form. Your information will be kept private and we will be in touch regarding next steps.

IN ADDITION: If relevant, please also consider completing the Irvington Vulnerable Persons Registry if you have a mobility, physical health, or mental health conditions that would necessitate increased or specialized support in the event of an emergency. Identifying yourself on this form will help the village
• Develop targeted emergency plans
• Coordinate resource allocation
• Provide specialized support during emergencies
• Communicate effectively with vulnerable individuals




Important: Registration is completely voluntary. Registered individuals consent to the municipal emergency management team sharing their information in case of an emergency. This form is offered as a community service, meant to increase the public good. Everyone using this form participates at their own risk. This form - but not your answers - can be viewed by anyone online who has its link; it is not a private document. It is each person’s responsibility to follow public health recommendations, all laws and regulations, personal safety practices, and their own research  in order to participate in this buddy system safely and legally, at their own risk.
Sign in to Google to save your progress. Learn more
Name *
Email *
Phone Number *
Address *
Age Range *
Required
Have you ever received training in: *
Required
Do you have an other special skills that could be of particular use during a community emergency?
Would you be willing to serve as an Emergency Preparedness Community Liaison between the village and your neighborhood?
Clear selection
Is there anything else you would like to share related to Irvington Emergency Preparedness 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms