June 27th Lava Flow Community Needs Survey

This survey is a joint effort of Hawai'i Island United Way and Hawai'i County Civil Defense. We are very grateful for the help of Dr. Mark Kimura and Dr. Kathryn Besio, both from the University of Hawai'i Department of Geography and Environmental Sciences. **Please submit one response per household.**

    This survey is intended to capture the needs of the community that may be affected should the lava cross Highway 130. Your participation in this survey is voluntary. Information provided may be shared with health and human service providers to assist in their planning and collaboration response. You do not need to give your name unless you wish to. Mahalo for your time and your participation!

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    YOUR HOME AND FAMILY

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    0-2 Year
    3-4 Years
    5-12 Years
    13-17 Years
    18-29 Years
    30-59 Years
    60-75 Years
    76+ Years
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    PETS AND LIVESTOCK

    This section will help us understand the needs of households with animals.
    Dog/Cat/Other Pet
    Small Livestock
    Large Livestock
    Fish/Aquaculture 
    Other
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    TRANSPORTATION

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    EVACUATION PLANS

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    AREAS OF CONCERN

    Access to basic needs: Food, Gas
    Access to routine medical services
    Care for medically fragile household member (wheelchair bound, bedridden, special needs)
    Emergency Medical Services (such as would require an ambulance)
    Access to mental health services
    Transportation to work
    Transportation to preschool or K-12
    Transportation to UHH or HCC
    Public Safety: Fire and Police
    Public Utilities: Water, Electricity, Roads
    Uninterrupted mail service
    Uninterrupted communication services: Phone, Internet
    Financial impact the lava flow will have on my household
    Air Quality
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    REQUEST FOR ASSISTANCE (OPTIONAL)

    The following questions are optional. Please fill out the section below only if you would like to be contacted by a health and human service provider for assistance. Eligibility criteria may apply.
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    MAHALO!

    Thank you for your voluntary participation. The information you provided will help health and human service providers plan and collaborate to best address community identified needs. If you have any questions regarding the outcomes of this survey, please call (808) 464-3175 or email contact@kokuapuna.org
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