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

JWH Rapid Response Alternative Housing

JWH Rapid Response Alternative Housing

Needs Assessment Survey

Shelter Survey Section 1

If you do not see a necessary service here, ask us

Our response will be

YES WE CAN

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.

Shelter Survey Section 2 Disaster-related emergency housing

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

form mail


Shelter Survey Section 3 Training or work camp

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.

form mail


Shelter Survey Section 4 Housing for homeless individuals

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?

form mail


Shelter Survey Section 5 Barracks for troops, guards

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.

form mail


Shelter Survey Section 6 Prison or detention camp

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.

form mail


Shelter Survey Section 7 Housing for unwed mothers

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.

form mail


Shelter Survey Section 8 office space, laboratory or training room space, accommodation of entertainment events.

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

form mail


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