Needs assessment for temporary housing systems. Add-ons such as mobile kitchens, laundry facilities, water purification systems

JWH Rapid Response Temporary Housing

Needs Assessment Survey

Shelter Survey Section 1

Thank you for responding to our survey. This is the best way for us to design the shelter solution that will solve your need.

Please check all options below that apply and supply any comments requested.

Use of Shelter	Comment	Action
Disaster-related emergency housing	Current need –a)	Proceed to Section 2
Disaster-related emergency housing	Contingent need –b)	Proceed to Section 2
Training or work camp		Proceed to Section 3
Housing for homeless individuals		Proceed to Section 4
Barracks for troops, guards		Proceed to Section 5
Prison or detention camp		Proceed to Section 6
Housing for unwed mothers		Proceed to Section 7
Training room (class rooms)		Proceed to Section 8
Laboratory		Proceed to Section 8
Office space		Proceed to Section 8
Accomodation of entertainment events		Proceed to Section 8
Other		Complete COMMENT
(a- CURRENT NEED: we will assemble shelters as soon as they are manufactured.
(b- CONTINGENT NEED: We will manufacture shelters and store them in case of disaster.

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate? MALE?
How many individuals do you need to accommodate? FEMALE?
How many individuals do you need to accommodate? Age 21 to 65?
How many individuals do you need to accommodate? Over 65?
How many individuals do you need to accommodate? UNDER 21?
How many individuals do you need to accommodate? Handicapped / Special Needs?
How many individuals do you need to accommodate? PETS?
Will you require cafeteria facilities?
Will you require laundry facilities?
Please supply a list of any special items you will require, such as projectors, furniture. Please describe construction site, availability of electricity, water, sewage, phone.
What add-on requirements will you have?	Furniture: bed and living area Linen: sheets, towels, etc. Sidewalks (portable, temporary) Convenience store Television sets, computers, cell phones Medical clinic supplies Pet care facility including vet Day Care Shuttle bus Self-Storage

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate in total?
How long will you require the facility?
Will you require cafeteria facilities?
Will you require laundry facilities?
Will you require a classroom-style training facility?
Please supply a list of training aids you will require, such as projectors, etc. Please describe construction site, availability of electricity, water, sewage, phone.

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate in total?
How long will you require the facility?
Will you require cafeteria facilities?
Will you require laundry facilities?

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate in total?
How long will you require the facility?
Will you require cafeteria facilities?
Will you require laundry facilities?
Please indicate any special requirements such as secure weapons storage area. Please describe construction site, availability of electricity, water, sewage, phone.

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate in total?
How long will you require the facility?
Will you require cafeteria facilities?
Will you require laundry facilities?
Please indicate any special requirements such as fencing Please describe construction site, availability of electricity, water, sewage, phone.

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate in total?
How long will you require the facility?
Will you require cafeteria facilities?
Will you require laundry facilities?
Please indicate any special requirements such as a medical clinic? Please describe construction site, availability of electricity, water, sewage, phone.

Name:
Company/Organization/Location/City
Email Address:
How many individuals do you need to accommodate in total?
How long will you require the facility?
Will you require cafeteria facilities?
Will you require laundry facilities?
Please supply a list of any special items you will require, such as projectors, furniture. Please describe construction site, availability of electricity, water, sewage, phone.
What add-on requirements will you have?	Furniture: bed and living area Furniture: office Linen: sheets, towels, etc. Sidewalks (portable, temporary) Convenience store Television sets, computers, cell phones Medical clinic supplies Pet care facility including vet Day Care Shuttle bus Self-Storage