$20,000 $61,000-$80,000 $21,000-$40,000 $81,000-$100,000 $41,000-$60,000 More than $100,000 A13. How many years have you and your family lived in South Louisiana? 1-5 6-10 11-20 21-30 More than 30 Less than 1 years years years year years A14. Please indicate any of the following you experienced as a result of the recent hurricanes (i.e. Katrina, Rita, Gustav, Ike): (Check all that apply) Yes No Yes No Loss of personal property Destroyed than house House Damaged Became seriously ill Victimized (i.e. robbed, physically Injured assaulted) Friends/Family Members House Loss of Business Destroyed/Damaged Loss of Income Friends Injured Family Members Injured Friends Killed Family Members Killed First Responder A15. What concerns do you have about the impact of this oil spill (Check all that apply)? Yes No Yes No Damage to wildlife and the natural Loss of personal or family business environment Health concerns about food Loss of job opportunities sources from local waters Needing to relocate Personal health effects Loss of tourism Other concerns Loss of usual way of life Participated in recovery A16. Did you apply for financial assistance from BP following the oil spill? Yes No A17. If yes to A13, have you received all of your financial assistance yet? Yes No A18. Using a 0 - 4 scale where 0 represents “not at all” and 4 represents “extremely”; please mark ONE circle for each scale... Not at all Mildly Moderately Markedly Extremely 0 1 2 3 4 The oil spill has disrupted your work*/school work: * Work includes paid, unpaid volunteer work or training I have not worked /studied at all during the past week for reasons unrelated to the oil spill. The oil spill has disrupted your social life/leisure activities: The oil has disrupted your family life / home responsibilities: Adapted from the Sheehan Disability Scales
$20,000 $61,000-$80,000 $21,000-$40,000 $81,000-$100,000 $41,000-$60,000 More than $100,000 A13. How many years have you and your family lived in South Louisiana? Less than 1 year 1-5 years 6-10 11-20 years 21-30 years More than 30 years A14. Please indicate any of the following you experienced as a result of the recent hurricanes (i.e. Katrina, Rita, Gustav, Ike): (Check all that apply) Yes No Yes No Destroyed Loss of personal property than house House Damaged Became seriously ill Injured Victimized (i.e. robbed, physically assaulted) Loss of Business Friends/Family Members House Destroyed/Damaged Loss of Income Friends Injured Family Members Injured Friends Killed Family Members Killed First Responder A15. What concerns do you have about the impact of this oil spill (Check all that apply)? Yes No Yes No Loss of personal or family business Damage to wildlife and the natural environment Loss of job opportunities Health concerns about food sources from local waters Needing to relocate Personal health effects Loss of tourism Other concerns Loss of usual way of life Participated in recovery A16. Did you apply for financial assistance from BP following the oil spill? Yes No A17. If yes to A13, have you received all of your financial assistance yet? Yes No A18. Using a 0 - 4 scale where 0 represents “not at all” and 4 represents “extremely”; please mark ONE circle for each scale... Not at all Mildly Moderately Markedly Extremely 0 1 2 3 4 The oil spill has disrupted your work*/school work: * Work includes paid, unpaid volunteer work or training I have not worked /studied at all during the past week for reasons unrelated to the oil spill. The oil spill has disrupted your social life/leisure activities: The oil has disrupted your family life / home responsibilities: Adapted from the Sheehan Disability Scales
Disaster-PAST-Toolkit-Final-6-1.docx