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EDR Surveys

We are ready to begin the Community Outreach Program. Our first task is to ask each resident to complete the attached Emergency Disaster Response (EDR) questionnaire. This information will enable us to identify residents, children, pets and those with special needs, as well as, highlighting any potential hazards around the house such as propane or gasoline for generators or boats. This information will help the first responders in the event of an emergency such as a tornado, hurricane, etc. All information will be safeguarded and treated confidentially. We will be sharing the critical data with the P.G. Police and Fire departments to assist first responders identify those of you with special needs first. Ideally, this neighbor-to-neighbor approach will greatly improve our communication with one another and EOC personnel.

Please note that we need all residents, either single and multi-family residents to complete surveys whether, or not they are members of BSIA or not. Once we have completed all surveys we will identify each house with a standard form of ID, i.e., a small sticker or other readily identifiable marker that will enable the police, fire and EMS personnel to more quickly respond to an emergency.

We are very excited that we are beginning this major undertaking which will enhance the health and safety of our neighbors. Should you have any question Just contact Joe or Anita Sabatino @ 639-0608.


BSI COMMUNITY EMERGENCY RESPONSE TEAM SURVEY

BSIA, in conjunction with Punta Gorda Police and Fire Departments, request your cooperation to determine the PHYSICAL and MEDICAL status of all BSI residents to facilitate a fast and thorough response. Please complete all fields and checkboxes that apply to you.

BSI STREET ADDRESS:

NAMES:

PHONE: CELL: E-MAIL:

# OF ADULTS: CHILDREN: INFANTS:

PHYSICAL AND MEDICAL CONDITIONS OF SPECIAL NOTE: (e.g.) AMBULATORY NON-AMBULATORY WALKER WHEELCHAIR OXYGEN

SPECIAL MEDICAL CONDITIONS(S):

PETS: DOG CAT OTHER

IS YOUR HOUSE EQUIPPED WITH AN EMERGENCY GENERATOR? YES NO
DO YOU STORE GASOLINE(GAS CAN, ETC): YES NO # OF GALLONS: PROPANE TANK: YES NO -----------------------OXYGEN CYLINDERS: YES NO

OPTIONAL:
ARE YOU FULL-TIME OCCUPANTS? YES NO
WILL YOU BE AWAY DURING SUMMER MONTHS? YES NO
APPROXIMATE DATES HOUSE IS EXPECTED TO BE UNOCCUPIED

ANY MEDICAL/DISASTER TRAINING?


COMMENTS:

After completing the form above, we suggest that you print the completed form before clicking on the Submit button below:

Whenever your family circumstances change, please submit a revised survery

 

 

 

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