Neighborhood Assessment Checklist

1
Neighborhood Assessment Checklist
Name_______________ Date/Time_____________
Ver. 6 (1 Aug 2008)

• Location ________________________________
• Road Blockage (A)
• Trees (1)
• Debris (2)
• Water (3) _______________________________
  ______________________________________
• Road Passable (4) Y/N_______
• Home Damage (B)
• Destroyed (1)
• Major (2)
• Minor (3) _______________________________
  ______________________________________
• Water/Flood (4)
• Medical Injury (C)
• Critical (1)
• Routine (2) _________________________________
  ____________________________________
• Other Hazardous Situations (D)

• Location ________________________________
• Road Blockage (A)
• Trees (1)
• Debris (2)
• Water (3) _______________________________
  ______________________________________
• Road Passable (4) Y/N_______
• Home Damage (B)
• Destroyed (1)
• Major (2)
• Minor (3) _______________________________
  ______________________________________
• Water/Flood (4)
• Medical Injury (C)
• Critical (1)
• Routine (2) _________________________________
  ____________________________________
• Other Hazardous Situations (D)

Notes on Assessment Process - In most cases,
assessment teams do not respond to events. Teams
record, notify CRC and continue with assessment
process. - Gas leaks from broken pipe is
extremely hazardous. Leave area immediately,
notify CRC and prepare to evacuate area. -
Assessment team minimum equipment Hard Hat,
vest, radio, extra batteries, assessment
checklist recording material, lights, water
bottle.