Survey to inform recovery
North LA Interfaith has created this survey to identify the areas most impacted by storm damage and power outages. You can help by taking the survey below.

Please share the link with your family, friends and neighbors. The survey lives at

The information collected here will not be shared outside of emergency response.
Sign in to Google to save your progress. Learn more
What's your zip code? *
What's the electricity situation where you live? *
On a scale of 1 to 5, how would you rate your current situation? (answer for yourself & household) *
1 = we're fine
5 = I or someone in my family is in crisis
Does someone in your household use a medical device that needs electricity? 
Clear selection
As the temperature rises over the next few days, do you have access to a place with electricity to cool off?
Clear selection
Do you need help finding or getting to a cooling site? 
Clear selection
Please share your biggest concerns right now:
First Name:
Last Name:
Phone Number:
Email address:
If you're a member of a congregation or civic organization, please share which one(s):
Clear form
Never submit passwords through Google Forms.
This form was created inside of Report Abuse