Flashlight and batteries Contact lens solution Portable radio (battery powered and receives weather/emergency Prescriptions/medicines (including a list of all medication announcements) names, dosages, prescribing physician, telephone numbers.) Extra batteries Copy of medical insurance card Sleeping bag/bed roll/blanket and pillow Personal first aid kit Sewing kit Sunscreen Travel alarm clock Bug spray _____________________________________________ _____________________________________________ Appendix B Initial Community Needs Assessment Name __________________________ Date_________________ Town __________________________ County ________________ Fill out separate form for each town Estimated Impact Loss Categories Number of Persons Type of Loss Number Dead Hospitalized Non-hospitalized Injured Homes destroyed Homes “Major Damage” Homes “Minor Damage” Disaster Unemployed (Others—Specify)
Flashlight and batteries Portable radio (battery powered and receives weather/emergency announcements) Extra batteries Sleeping bag/bed roll/blanket and pillow Sewing kit Travel alarm clock _____________________________________________ Contact lens solution Prescriptions/medicines (including a list of all medication names, dosages, prescribing physician, telephone numbers.) Copy of medical insurance card Personal first aid kit Sunscreen Bug spray _____________________________________________ Appendix B Initial Community Needs Assessment Name __________________________ Date_________________ Town __________________________ County ________________ Fill out separate form for each town Estimated Impact Loss Categories Number of Persons Type of Loss Number Dead Hospitalized Non-hospitalized Injured Homes destroyed Homes “Major Damage” Homes “Minor Damage” Disaster Unemployed (Others—Specify)