SV Community Emergency Response Team Survey

Our Santa Venetia Community Emergency Response Team (CERT) is made up of local volunteers who train to do basic disaster response for flood, earthquake and fire. But we can’t do it alone. A disaster will require as many hands as possible, so we need to know our neighbors and how we can help each other. This survey is one way we hope we can be ready to do that. Please share whatever information about yourself and your family you are comfortable sharing.

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Name *

First

Last

Address *

Phone

Email *

Approximately how long have you lived in Santa Venetia?Less than 2 years2-5 years5-10 yearsMore than 10 years

In any emergency the community will need to help itself until official assistance arrives. Would you like to contribute any of the following skills or supplies?

Healthcare Skills:

• Doctor
• Nurse
• Medical Assistant
• EMT/Paramedic
• Mental Health Training
• Veterinarian
• Wilderness Emergency Training
• Other

Other Healthcare Skills:

Search & Rescue Training:

• Yes
• No

Trade Skills:(to respond to structural damage)

• Construction
• Plumbing
• Electrical
• Other

Other Trade Skills:

Education:

• DayCare/Teacher
• Leadership in Emergency Situations
• Police or Security
• Multi-Lingual
• Other

add Languages: you

Other Education/Leadership Skills:

Languages:

• Spanish
• French
• Italian
• Chinese
• Arabic
• Other

Other Languages:

Miscellaneous:

• Heavy Lifting
• Transporting Materials
• Animal Care
• People Skills(crisis counseling, etc)
• General Assistance(get coffee, comfort kids)
• Additional Comments

Please add any additional comments to Miscellaneous:

Equipment & supplies:

• Wheelchairs & Walkers
• Boats(Kayaks, canoes, paddleboards, skiffs)
• Floation Devices, dry bags
• Tools(Hammer, saws, etc)
• Sandbags
• Animal Containers
• Rope
• Extra Warm, dry clothes
• Additional Comments

Please add any additional comments to above Equipment & Supplies:

Any additional comments we should know about in a Disaster Situation:

Submit