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Shared Capabilities Sheet
SALLT Preparedness Circle
Email address *
Name: *
Your answer
On a scale of 1-10, how prepared is your church family for a disaster?
Not Prepared
Totally Prepared
I. Church, Ministry or Business Name:
A. Type of Organization:
Physical Address:
Street Address:
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City:
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Zip Code
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Office Phone
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Cell Phone
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Office Email
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Church Website
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Fax
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Fax
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Pastor First Name
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Pastor Last Name
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Pastor Phone
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Pastor Email
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Prayer Leader First Name
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Prayer Leader Last Name
Your answer
Prayer Leader Phone
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Prayer Leader Email
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Would you like your prayer team updated on prayer points for the relief effort?
B. Disaster Relief Coordinator (DRC) (This is the contact point, whether interim or long-term)
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First Name:
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Last Name:
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Phone:
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Email:
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C. Church size:
Number of active members:
D. Volunteers available:
Please give an approximate number of volunteers you may expect to respond to local disasters. Are any members trained already? By whom? Red Cross?
Your answer
E. Bilingual:
Is your church community bilingual?
F. Storage Space:
In the event of a catastrophic disaster, how much space can you designate for storage within your facility? (i.e., food, clothing, supplies, etc.) Warehouse space is addressed below.
Your answer
G. Food Prep:
Do you have food preparation/serving facilities?
H. Showers:
Do you have showers within your facility, and if so how many?
Your answer
I. Showers nearby:
Are you close to a YMCA, school, or facility with showers?
Your answer
J. ADA:
Is your facility able to assist American's with Disabilities? (ADA compliant, wheelchair ramps, grab bars etc?)
II. Which of the following categories can you provide services in?
Click all that apply & list details below if you are able to at this time
A. Food:
Does your church have a food Pantry? Do you partner with a local food Pantry? Do you have members willing to share large portions of food as a part of their businesses? (In an emergency we would ask for an approximate inventory of what your church body would provide at that time in the area of food (i.e. 30 lbs of red meat, 100 lbs of chicken, 2 grills etc.)
Your answer
B. Clothing:
Does your church have a clothing ministry or thrift store? Do you partner with local nonprofits in this area already? (In an emergency we would ask for an approx. inventory of what you can provide at that time in the area of CLOTHING- i.e. adult men and women's clothing, children's clothing from infant to 3 yrs of age etc.)
Your answer
C. Shelter:
Does your church have a gymnasium or large areas in which to shelter families effected by disaster? Do you partner with a local shelter already? (In an emergency we would ask for an approx. inventory of what you can provide in the area of SHELTER at that time- i.e. 2 houses for men with 4 rooms each, unisex shelter for 150 people, and/or 10 apartments, 20 hotel rooms, etc.)
Your answer
Volunteer Sheltering
Would your church be willing to shelter volunteers in addition to families effected by disaster?
Your answer
D. Warehouse:
(approx. inventory of what you can provide in the area of WAREHOUSE space- i.e. 10,000 sq.ft. of storage for 3 months, 15,000 sq.ft. for storage etc)
Your answer
E. Transportation:
(Approximate inventory of what you can provide in the area of TRANSPORTATION- i.e. Transportation: 6 school buses, 3 full size vans, 2 full size 26' moving trucks, back-hoes, trailers, etc.)
Your answer
F. Furniture:
Does your church have a furniture ministry already? Do you partner with nonprofits in the area already in this area, and if so who? (In the event of an emergency we would ask for an approximate inventory of what you can provide at that time in the area of FURNITURE- i.e. 5 kitchen tables, 3 sofas, 15 queen size beds, etc.)
Your answer
G. Misc. Resources unique to your church or church body make up:
Your answer
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