Member Agencies - Locations & Assets
Organization Name *
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Location Address *
Your answer
Office Phone Number *
Your answer
Emergency Point of Contact (POC) - Name *
Your answer
POC Mobile/24 Hour Phone Number *
Your answer
POC Email Address *
Your answer
Interests specific to this location *
Yes
No
Maybe
Already included in the National Shelter System?
Interests as a National Emergency Shelter?
Interests as a Point of Distribution (POD)?
Interests as a VOAD Emergency Warehouse?
Are you interested in being a Disaster Volunteer Center (DVC)?
Hard Assets
Equipment
Please select the quantity range (found in the columns) for each available row
1
2
3
4
5
6
7
8
9
10
10+
Permanent Standby Generator
Portable Generator
Commercial Kitchen
Mobile Kitchen
Box Truck
Forklift
Portable Bathroom
Portable Shower
Supplies
Please select the quantity range (found in the columns) for each available row
1-50
51-100
101-150
151-200
201-250
251-300
301-350
351-400
401-450
451-500
500+
Tents
Sleeping Cots
Sleeping Blankets
First Aid Station
Automated External Defibrillator (AED)
Wheelchairs
Amateur (HAM) Radio
Soft Assets
Skills & Specialties
Please select the number of skilled personnel (found in the columns) for each available row.
1-2
3-4
5-6
7-8
9-10
10+
Mental Health Specialists
Translators - Spanish
Translators - Chinese
Translators - Tagalog
Translators - Korean
Translators - Armenian
Translators - Vietnamese
Translators - Farsi
Translators - Japanese
Translators - Russian
Translators - American Sign Language
Licenses
Please select the number of personnel (found in the columns) for each available row.
1-2
3-4
5-6
7-8
9-10
10+
HAM Radio Operators
Driver's License - Class A (Commercial Driver's License)
Driver's License - Class B
Forklift License
Certified Plumbing License
Licensed Electrician (i.e. Class C-10)
Licensed Roofing Contractor
Other Information
Your answer
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