Occupy Assessment
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TitleQuestionAlternate VersionsTypePriority (1=highest)FollowupableCommentsCategoriesStatic/Dynamic
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Addresstext1Contact
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Best time to visitPreferred delivery timetimestamp3Contact
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Cell Service (reliable; unreliable; yes; no)list--reliable, unreliable, yes, no2Contact
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Emailtext1NContact
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ETA for pickup (kitchen)timestamp3Contact
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Language Spokentext1Contact
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Nametext1Contact
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Neighborhoodtext1Contact
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Owner's signature (to work on property)signature3Contact
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PhoneContact #text1NContact
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Senders IPtext3meaning unclearContact
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Vacant?Y/N2Contact
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ZoneID2Contact
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Animals: Do you have pets?Y/N2Household
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Animals: Lost?Y/N2Household
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Animals: Need pet supplies?Y/N2Household
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Animals: need veterinarianY/N2Household
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Car (number of)text2Household
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Children under 18 or adults over 65 in household?Y/N3Household
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Disabled people living here?Y/N1ideally a numberHousehold
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HomeboundY/N1Household
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Living here now?Y/N1MERGE w -residency: staying in home?Household
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Occupancy: Number in HouseholdNo. of Occupantsnumber1Household
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Occupancy: Seniors living here?Y/N1Household
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Occupants (Number of Adults)number2- Phone, and email information is requested per occupantHousehold
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Occupants (Number of Children)Are there children living here?number1Household
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Occupants (Number of Seniors)number1Household
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Cleanup/Demolition needs-Repairs check ( cleaning, removing debris, gutting, repairing roof, liasing w/ landlord)Y/N1Housing
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Damage?Y/N1Housing
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Damage/Problems: DrywallY/N2Housing
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Damage/Problems: ElectricalY/N1Housing
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Damage/Problems: Electrical problems (days without)number2Housing
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Damage/Problems: Flooded basementY/N2Housing
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Damage/Problems: FlooringY/N2Housing
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Damage/Problems: Gas problems (days without)number2Housing
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Damage/Problems: Heat (days without)number1Housing
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Damage/Problems: MoldY/N1Housing
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Damage/Problems: PlumbingY/N1Housing
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Damage/Problems: RoofY/N2Housing
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Damage/Problems: Sewagey/n2Housing
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Damage/Problems: Water (days without)?number2Housing
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Damage/Problems: water damaged basementY/N2Housing
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Damage/Problems: water damaged floorY/N2Housing
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Damage/Problems: Water-hot (days without)?number2Housing
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Did your flood insurance payout cover all repairs?Y/N2Advocacy
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Did you rent out any part of your home pre-Sandy?Y/N3Other
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Did you stay at home during Sandy?Y/N3Housing
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Do you need help with lender problems?Y/N2Advocacy
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Flood insuranceDo you have flood insurance?Y/N2Housing
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Have insurance?Y/N3ambiguousHousing
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DisplacementHave you been displaced from your home?Y/N1Housing
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Flood insurance paymentsHave you received flood insurance payments?Y/N2Advocacy
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Insurance claim help needed?Y/N2Advocacy
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Is your current housing situation safe and stable?Y/N1Ybetter: do you need help finding housingHousing
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Labor needs?text2Housing
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Landlord-tenant dispute?- NYCHA? - Name of LandlordY/N2Advocacy
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Mortgage ( having problem paying)check box2- name of lender askedHousing
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Insurers: Nametext2should specify type of insuranceHousing
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Need help with repairs?Y/N2Yshould specify damages, possibly priority 1Housing
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Need safe place to sleep?Y/N1could merge with finding housing (line 55)Housing
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Plumbing? (do you have)?Y/N1reverse of question damage:plumbingHousing
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Redisency: Without electricityY/N1YHousing
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Redisency: Without gasY/N2YHousing
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Redisency: Without generatorY/N2YHousing
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Redisency: Without heatY/N1YHousing
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Redisency: Without sewageY/N1Yconfusing with plumbingHousing
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Redisency: Without waterY/N1YHousing
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Residency: do you have insurance?Y/N1Housing
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Residency: home-owner?Y/N1Housing
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Residency: Homeless?Y/N3redundant with need to find safe placeHousing
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Residency: Need help relocatingY/N1Housing
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Residency: Rental help needed?Y/N2ambiguousHousing
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Residency: renter?Y/N1Housing
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Residency: Repairs: Need help with cleaningY/N2YHousing
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Residency: Repairs: Need help with guttingY/N2Housing
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Residency: Repairs: Need help with mold treatmentY/N1Housing
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Residency: Repairs: Need help with otherY/N2Housing
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Residency: Repairs: Need help with rebuildingY/N1could be merged with other repairsHousing
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Residency: select plan to stay in homeselect--right now or long term3Housing
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Residency: Without water-cleanY/N2no one knew the answerHousing
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Where are you staying?multiple choice3possibly redundant with aboveHousing
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Canvassed ByVolunteer OR Form Writertext1Intake
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DateTimestamptimestamp1Intake
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Immigration rights: has your immigration status prevented you from seeking assistanceY/N1Advocacy
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Immigration rights: have you been discriminated against?Y/N3Advocacy
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List other organizations doing disaster relief work in your areatext3Organizing
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Potential LeaderWhy; concerns in leaders community2Organizing
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Interested in: attending a community meeting?Y/N1Organizing
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Interested in: helping to start a worker-owned business?Y/N3Organizing
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Interested in: helping to start a worker-owned business?: If so, whar are your interests and/or areas of expertise?text3Organizing
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Would you like Occupy Sandy NJ to help you find work?Y/N3Advocacy
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Would you like to get involved in environmental and/or climate change projects?Y/N3Organizing
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Would you like to get involved in social/economic justice projects?Y/N3Organizing
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Would you like to help coordinate volunteers in your community?Y/N2NOrganizing
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Assessment needsY/N?ambiguousOther
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Did hurricane sandy impact your businessY/N3Other
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Did hurricane sandy impact your propertyY/N3Other
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Did hurricane sandy impact your work?Y/N2Other
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Do you need volunteers?Y/N3Ymaybe redundant with labor needs?Other
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