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Ida Recovery Needs Assessment

Together Baton Rouge is developing an organizing strategy for Ida recovery. We would like to know how the hurricane has impacted you and your family. We will be working with community partners to support as many families as possible. Please respond to the following survey and share with your family and friends. If you are in contact with someone who does not have internet access you can submit multiple forms, for yourself and others.
Together Baton Rouge
First Name
Last Name
Prefix
Address
City
Zipcode
Phone Number
Email Address
Name of institution(s) (community organization, religious congregation, neighborhood association, etc.) that you are a member of:
How many children are currently in your home? (0-17 years of age)
How many elderly persons requiring supportive care are in your home?
Was your property significantly damaged?
Clear selection
If yes, please describe the damage to your property:
Did you lose power?
Clear selection
Has your power been restored?
Clear selection
Do you have a generator?
Clear selection
Are you concerned about a power supply for your generator? (Gas, batteries, etc.)
Clear selection
If yes, please describe your power supply needs:
Are you concerned about your supply of food/water?
Clear selection
If yes, please describe your food/water needs:
Are you lacking access to any medications, or will you soon lose access to any of these medications?
Clear selection
If yes, please describe your medication needs:
Has Hurricane Ida affected your employment/ability to work?
Clear selection
If yes, please describe any work-related challenges:
Do you have access to reliable transportation?
Clear selection
If no, please describe any transportation needs:
Please use this space to list any additional needs/concerns:
Are you available to volunteer for Ida Recovery efforts?
Clear selection
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